Sensory mechanisms in mammalian teeth and their supporting structures

Dentin-predentin complex and its permeability: physiologic overview

The major channels for solute diffusion across dentin are the dentinal tubules. Since dentin permeation is proportional to the product of tubule number and diameter, both of which increase as the tubules converge on the pulp, we find that dentin permeability increases rapidly as the pulp chamber is approached. The presence of a smear layer of cutting debris on top of cut dentin decreases dentin permeability, especially when permeability is measured by fluid filtration. Further, intratubular material--such as mineral deposits, collagen fibrils, proteoglycan linings, bacteria, etc.--can greatly reduce dentin permeability. Although the presence of irregular or irritation dentin has been thought to greatly reduce dentin permeability, recent in vivo experiments in dogs indicate that the dentin permeability of freshly cut cavities prepared in sound dentin falls very rapidly (i.e., 50-60% in the first six hours) before any histologic changes can be detected, either in the pulp or the dentin. When dogs were depleted of their plasma fibrinogen, this rapid decline in dentin permeability following cavity preparation failed to take place. The results implicate leakage of plasma proteins from the underlying pulpal vessels. The proteins subsequently permeate the tubules, where they are either adsorbed to the tubule walls or physically trapped in such a way as to reduce dentin permeability.

Changes in pulp temperature during thermostimulation of human teeth by a simple electrically controlled thermode

A simple electrically controlled thermode is described that was used in psychophysical experiments on thermoperception from teeth in human subjects. The time course of the intrapulpal temperature changes during a 60 s cooling or heating procedure was measured in in vitro experiments in which the temperature exchange between tooth and surrounding tissue, present in the psychophysical experiments, was stimulated.

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.

Sensory innervation of periodontal ligament of rat molars consists of unencapsulated Ruffini-like mechanoreceptors and free nerve endings

The trigeminal ganglion (TG) of adult rats was injected with 3H-amino acids to label periodontal receptors by axonal transport; 20-24 hours after injection, samples of molar ligament were prepared for autoradiography and electron microscopy. Four types of neurites labeled from TG were found in the avascular ligament fiber regions: large, complex, Ruffini-like endings, lacking a capsule, but with finger extensions touching ligament collagen; smaller Ruffini-like endings, lacking a capsule and neural fingers; free bundles of unmyelinated axons; and free, small, myelinated axons. The vascular channels plus associated loose connective tissue that perforate the ligament contained labeled preterminal ensheathed axons, small Ruffini endings, and free unmyelinated or small myelinated axons. The incidence of labeled endings was about 5 X greater next to the lower third of the root than in the upper two-thirds or beneath the root. The TG myelinated axons (diameter range 2-15 microns) entered the ligament in sheathed nerve bundles; these branched to form numerous small preterminal axons that were surrounded by a periaxonal fluid space and a perineurial sheath. Terminal axons branched from nodes of Ranvier, left the preterminal chamber, and followed an extended branching course through the collagen fibers. Large, complex Ruffini-like endings had numerous mitochondria and were partially covered by special lamellar Schwann cells and complex basal lamina; vesicles and multivesicular bodies were found near exposed regions of the receptor. Smaller Ruffini-like endings lacked neural fingers and had a simpler structure and less elaborate Schwann cells. The structure of Ruffini-like endings was highly varied; thus a structural continuum may exist from the largest, most complex to the smallest, simplest Ruffini-like receptor. The TG unmyelinated axons entered the ligament in ensheathed bundles; they then branched into free bundles that were found in the avascular ligament or near blood vessels. No encapsulated receptors were found.

Spatial summation of pre-pain and pain in human teeth

The purpose of this work was to investigate the relation between the sensations of pain and 'pre-pain' evoked by stimulation of teeth in human subjects. Electrical pulses of progressively increasing amplitude, generated by a computer-controlled stimulator, were applied to 1 or 2 teeth, and the subjects responded by indicating the nature of the resulting sensation. Pre-pain and pain could be readily and rapidly distinguished by all 11 subjects (response latency about 0.4 sec). Both sensations had stable thresholds with relatively small variance (S.D. 10-15% of threshold value) for a given subject. Subjects characterized the stimuli as indifferent or unpleasant, localized, and brief. By using special stimulation strategies (termed 'optimal trajectories') for exciting 2 teeth simultaneously, spatial summation for pre-pain was demonstrated in most subjects and for pain in almost all subjects. Spatial summation of pre-pain resulted in pain rather than in more intense pre-pain. These results are consistent with both the dual modality (separate afferent fibers for pre-pain and pain) and the single modality hypotheses (single type of afferent fibers) of tooth pulp sensibility, but favor single modality innervation.

The spatial distribution, intensity and unpleasantness of acute dental pain

The distribution, intensity and unpleasantness of acute dental pain were studied in 196 patients. Dental pain was classified by source according to 7 anatomical sites: dentinal, pulpal, pulpal and periapical, periapical, pericoronal, papillar, and periodontal. The distribution of dental pain was classified by the frequency of pain spread throughout the sample, by the extent of pain spread for a particular pain source, that is, the number of vectors of spread, and by the pain reference locations in the face and head. Pain-intensity and pain-unpleasantness were assessed on Visual Analogue Scales. The frequency and extent of pain spread varied as a function of source. However, specific patterns of pain spread were not associated with particular pain sources. There was considerable overlap in patterns of spread between maxillary and mandibular pain sources. The frequency and extent of pain spread was correlated positively with both pain intensity and pain unpleasantness. The correlation between pain ratings and pain spread may be attributed to central mechanisms and interactions between trigeminothalamic neurons. Spatial overlap of pain from maxillary and mandibular pain sources may be due to the large receptive fields of wide dynamic range neurons, that can extend beyond one trigeminal division. These observations indicate that the spatial distribution of acute dental pain is not sufficient as a diagnostic tool for indentifying pain source.

Histology, innervation and radiographic appearance of fetal rat tooth germs developing in oculo

Rat molar and incisor tooth germs from gestational days 18-21 were homologously grafted to the anterior eye chamber of adult recipients. The fetal tooth transplants survived and grew considerably in the eye, attached to and vascularized from the anterior surface of the host iris. Grafts were examined histologically and compared with in situ controls after up to 6 months in oculo. Radiographic examinations of the grafts showed a normal rate of mineralization and a distinct enamel/dentin border after intraocular development. The size of the tooth grafts was somewhat smaller than in situ but the grafted teeth attained a form much resembling in situ incisors and molars. Light microscopy revealed a regular dentin and predentin, a distinct dentin/enamel border and a well innervated and vascularized pulp. No degenerative changes in dentin or enamel layers could be found in long-term grafts (6 months). Thus, intraocular tooth grafts in rats develop many histologic and anatomic features typical of normal teeth, emphasizing the importance of intrinsic regulatory mechanisms in tooth development.

Perception of pulpal pain as a function of intradental nerve activity

The purpose of the present investigation was to find neurophysiological correlates of pain perception. The magnitude and time course of perceived pain was successfully related to the neural discharge evoked by rapid cooling of the tooth surface in 6 dental patients whose lower incisors were to be extracted for prosthodontic reasons. Two cavities were prepared on the facial surface of human lower incisors. The cavities were deepened using hand driven instruments until the pulp was visible through a thin layer of dentin. A metal tube was placed in contact with amalgam on each cavity bottom and fixed in place by composite filling material. The tubes were connected to standard equipment for electrophysiological recordings by a flexible circuit. The magnitude of perceived pain was assessed by a cross-modality matching to finger span in combination with sensory verbal pain descriptors and magnitude estimation. The striking agreement between the integrated nerve activity, probably of the A delta type and pain perception, is of great importance from the methodological point of view since it strongly argues in favor of the appropriateness of the techniques applied here to elucidate the neural substrate of some types of nociception and also to evaluate various means of relieving such pain.

Peptidergic nerves in human tooth pulp

Substance P-like and enkephalin-like immunoreactive nerve fibers were observed in the human tooth pulp. Immunoreactivity for substance P could be demonstrated in thin, beaded nerve fibers and glomerular-type nerve structures both in the center and in more peripheral parts of the tooth pulp. Substance P-like nerve fibers predominated in the center of the pulp substance, while a thicker type of enkephalin-like nerve fibers were more commonly seen at the periphery of the pulp. Controls exhibited no immunoreactivity for either neuropeptide. It is tentatively suggested that a dual innervation by substance P-like fibers and enkephalin-like nerve fibers may be involved in the mediation of toothache in man.

Dental sensory receptors

Teeth are innervated by unmyelinated sympathetic axons, and by unmyelinated and small myelinated sensory axons. Some sensory axons in teeth are terminal branches of larger parent axons, so that conduction from teeth to CNS in trigeminal nerves includes C-fiber, A-delta, and A-beta velocities. Sensory dental axons contain acetylcholine or substance P-like immunoreactivity. The sympathetic axons contain noradrenalin. Other neuropeptides may also be present, such as vasoactive intestinal peptide and serotonin. Dental axons of mature teeth of many species (man, monkey, cat, rodents, fish) are essentially the same, but continuously erupting teeth have smaller and fewer axons. Free sensory nerve endings in mature teeth are found in the peripheral plexus of Raschkow, the odontoblastic layer, the predentin, and the dentin. Free nerve endings are most numerous in those regions near the tip of the pulp horn, where more than 40% of the dentinal tubules can be innervated. Many dentinal tubules contain more than one free nerve ending. Intradentinal axons can extend as far as 0.2 mm into dentin but usually end less than 0.1 mm from the pulp. Some sensory endings also occur along pulpal blood vessels. In continuously erupting teeth nerve endings do not enter the dentin but remain within the pulp. Nerve endings in dentin are labeled by axonal transport. They are therefore as viable and active as the nerve endings in pulp. The axoplasm of the free nerve endings contains organelles typical of other somatosensory receptors. These organelles are most common in the successive beaded regions along the free nerve endings and include mitochondria, clear and dense-core vesicles, multivesicular bodies, profiles of smooth endoplasmic reticulum, and relatively few microtubules and neurofilaments. The beads can vary in size from about 0.2 to 2.0 microns and can have varying amounts of receptor organelles. The interbead axonal regions are thin and contain mainly microtubules and neurofilaments. Nerve endings are associated with companion cells after they leave the coronal nerve bundles; these companion cells include Schwann cells, fibroblasts, and odontoblasts. There is no good evidence of gap junctions or synapses between nerve endings and odontoblasts. Instead, the two cell types form appositions that have a 20-40 nm extracellular cleft and parallel apposed plasmalemmas but no unusual membrane-associated material. No special organelles occur in the odontoblastic cytoplasm at these sites.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of electrical thresholds of intradental nerves and jaw-opening reflex in the cat

In experimental animals the jaw-opening reflex in response to stimulation of pulp nerves has been used as a nociceptive reflex. However, there seems to be only scanty information about the amount and types of pulp nerve fibres that mediate the reflex. In the present work on 8 anesthetized cats electrical thresholds of single functional pulp nerve units were compared to the thresholds of jaw-opening reflex. Monopolar cathodal current pulses were applied to each canine tooth. Reflex responses of the digastric muscle were recorded. The inferior alveolar nerve of the left side in 3 cats was exposed for nerve dissection and responses of pulp nerve units coming from the lower left canine tooth were recorded. The mean threshold of the jaw-opening reflex with 10 ms pulses was 5.9 +/- 3.0 (SD) microA. Below or at the level only part of the fast conducting pulp nerve units could be activated. Thresholds of A- (n = 32) and C- (n = 24) fibres were 9.9 +/- 5.7 and 37.4 +/- 14.5 (SD) microA respectively. Nerves of the periodontal tissues (20 units recorded) were not activated with current pulses of up to 200 microA applied to the tooth. Consequently, at threshold level the jaw-opening reflex in response to the present type of stimulation is mediated by the fast conducting intradental nerve units.

Periaqueductal gray inhibition of trigeminal subnucleus caudalis unitary responses evoked by dentine and nonnoxious facial stimulation

The possible pain inhibitory effects of periaqueductal gray (PAG) stimulation were investigated in cats anesthetized with Nembutal and immobilized with Flaxedil. Unitary responses evoked by electrical stimulation of the upper canine dentine and by cutaneous facial noxious and nonnoxious stimuli were recorded extracellularly from the trigeminal subnucleus caudalis. A bipolar electrode was introduced into the PAG to test the effects of PAG excitation on the trigeminal response to dentine (TRED) and cutaneous nonnoxious stimulation. In some experiments, a similar electrode was lowered into the contralateral posterior thalamus to study the antidromic activation of subnucleus caudalis cells and the effects of thalamic stimulation on the TRED. Dentine stimulation evoked brief (6- to 15-ms) bursts of 1 to 10 spikes with 3- to 25-ms latencies. Most units (88%) were also activated by cutaneous facial stimulation. Stimulation of the posterior thalamus had no effect on the TRED or on responses to cutaneous stimulation, but activated antidromically 10% of the units. In 71% of the units PAG stimulation inhibited the TRED. In some of those cases (12%), the inhibitory effect persisted 30- to 60 s. The PAG stimulation could produce paradoxical effects, potentiating the TRED evoked by threshold intensity and inhibiting the TRED elicited by suprathreshold stimulation. About one-half the PAG points evoked detectable effects. Their location had no clear topographical distribution, although ventral sites were more potent than dorsal sites. Responses evoked by nonnoxious facial stimulation were also inhibited by the PAG.

Dental nerve regeneration in rats. I. Electrophysiological studies of molar sensory deficit and recovery

Return of sensory nerve function in rat molars following cut or crush injury to the inferior alveolar nerve (IAN) was measured by observing the jaw opening reflex (JOR) response of the digastric muscle to electrical stimulation of individual molars or the gingiva. The IAN was injured from a lateral approach to the mandibular ramus at a site approximately 2 mm proximal to the incisor apex. Following nerve injury, the JOR threshold to stimulation of the first molars increased 6-fold: preoperative threshold mean = 47.4 +/- 21.3 microA (n = 27), postoperative threshold mean = 248.5 +/- 127.1 microA (n = 25). A 4-fold postoperative increase in JOR threshold was found for the second molars, and the thresholds were not significantly affected for third molars or gingiva. These postoperative results indicated that the major pathway of sensory innervation to the first and second molars was affected by the IAN injury, whereas the third molars and gingiva had alternate sources of innervation which remained unaffected by the IAN injury. At 1 week following injury, there was partial return of sensitivity, by 3 weeks there was approximately 50% recovery, and by 6 weeks complete return to normal JOR thresholds was found. The degree of sensory deficit, as reflected in JOR inhibition, and the rate of recovery were not significantly different after cut or crush injury in these experiments; however, there was a tendency for greater sensory loss and for more rapid recovery after crush injury. This study forms the basis for a subsequent autoradiographic analysis of nerve location in rat molars of known sensory deficit, partial recovery, or full sensory recovery.

Non-pain and pain sensations evoked by tooth pulp stimulation

This study investigated the quality and magnitude of sensations evoked by electrical tooth pulp stimulation. Detection threshold (the minimum current intensity that evoked a sensation) and pain threshold were determined for tooth pulp stimuli varying in frequency from 5 to 500 Hz. The effect of frequency and intensity of tooth pulp stimulation on the magnitude of sensations was assessed using visual analog scales and verbal descriptor scales. Detection thresholds were stable over experimental sessions and independent of the frequency of the stimulating current. Pain threshold varied as a function of frequency with a minimum value at 100 Hz. Stimuli that evoked non-pain sensations at low frequencies evoked pain sensations when frequency was increased from 5 to 100 Hz. Subjects were able to scale non-pain sensations over a range of stimulus intensities and frequencies. The lowest currents evoked sensations that were non-painful and were of constant magnitude despite changes in the frequency of stimulation. Higher stimulus currents evoked sensations that were non-painful at low stimulus frequencies and painful at high stimulus frequencies. Sensation magnitude at each stimulus intensity increased as a function of frequency. Temporal summation occurred in proportion to stimulus intensity. These findings suggest that the non-pain sensations evoked in tooth pulp are mediated by a distinct population of afferents that are not involved in the coding of pain. High frequency stimulation that increased the discharge rate of the lowest threshold pulpal afferents resulted in no summation of non-pain sensation and never produced pain. However, high frequency stimulation evoked greater magnitude sensations at higher stimulus currents, indicating that central summation mechanisms were critical for higher threshold afferents signaling more intense non-pain and pain sensations.

Actions of GABA, glycine, methionine-enkephalin and beta-endorphin compared with electrical stimulation of nucleus raphe magnus on responses evoked by tooth pulp stimulation in the medial reticular formation in the cat

In decerebrate, cerebellectomized cats, a comparison was made between the effects of electrical stimulation in nucleus raphe magnus (NRM) and iontophoretic application of GABA, glycine, met-enkephalin and beta-endorphin on the responses of neurones in the medial brain stem reticular formation to tooth pulp stimulation. NRM stimulation, GABA, glycine and enkephalin produced a short lasting inhibition of tooth pulp evoked responses whilst the time course of the inhibition produced by beta-endorphin was much slower, often lasting up to 1 h following a 3-7 min ejection period. The effects of GABA and glycine could be antagonised by iontophoresis of bicuculline and strychnine respectively whilst intravenous injection of naloxone antagonised the inhibition induced by the opioid peptides. In most neurones tested, inhibition of tooth pulp evoked responses by NRM stimulation was blocked by iontophoretic application of bicuculline but not by strychnine or naloxone (i.v.). We conclude that GABA may act as a transmitter which mediates the inhibitory effects of NRM on the responses of reticular neurones to tooth pulp stimulation. Thus GABA may be involved in stimulation produced analgesia.

The distribution of mechanoreceptors in the periodontal ligament of the mandibular canine tooth of the cat

1. Periodontal mechanoreceptor activity has been recorded from fibres in the inferior alveolar nerve. 2. A method has been developed for punctate and electrical stimulation of the periodontal ligament mechanoreceptors through a thin layer of bone overlying the labial aspect of the left mandibular canine tooth root. 3. The distribution of periodontal mechanoreceptors in the labial aspect of the left mandibular canine tooth has been described. 4. All receptors located responded maximally when that part of the ligament in which they lay was in tension. 5. It is suggested that there may be only one type of mechanoreceptor and that the rate of adaptation is dependent on the location of the receptor within the periodontal tissues.

Dental sensory receptor structure in human teeth

Electron microscopy was used to study normal human extracted teeth in order to define the junctions between sensory nerve endings and other cells in external pulp and inner dentin at the crown tip. Two sets of associated cells were found: (1) Connective tissue cells. The pulpal fibroblast newtork made occasional desmosome junctions with the odontoblast newtork, and the cells of each network formed many gap junctions and desmosomes with one another. (2) Nerve endings. The terminal axons formed a succession of appositions with each other or with Schwann cells in the plexus of Raschkow and the cell-free zone, possibly with fibroblasts in the cell-free zone and odontoblast layer, and with odontoblasts in the odontoblast layer, predentin and dentin. The appositions between nerve endings and their companion cells at all levels usually maintained a regular intercellular spacing of at least 15-20 nm. In predentin and dentin, axons could be easily identified by their distinctive vesicles and mitochondria, and they often occurred within clusters of adjacent dentinal tubules; in the odontoblast layer axon identification was much more difficult. Axo-axonic appositions were found in the plexus of Raschkow, the cell-free zone, predentin and dentin; in many cases, bare axons were separated from each other only by a 5-10 nm extracellular space. Dental sensory mechanisms are discussed in relation to these observations.

Responses of intradental nerve fibres to stimulation of dentine and pulp

In the present work responses of intradental nerve fibres to stimuli that induce fluid flow in dentinal tubules as well as to direct mechanical irritation of the exposed pulp were studied on 9 young adult beagle dogs. Under pentobarbitone anesthesia 31 single functional intradental fibre units were dissected from the mandibular nerve. Stimuli were applied to the lower left canine tooth. Exposed dentine surface was irritated by scraping, air blasts and dry absorbent paper and the pulp mechanically with a von Frey hair. Ten fibre units responded to stimulation of dentine. Six of them were also tested with mechanical irritation of the pulp and were all responsive. Fifteen of twenty fibres responded to mechanical stimulation of the pulp. The mechanosensitive nerve fibres were all A-type according to conduction velocities (mean 25.6 +/- 8.1 (SD) m/s). It is concluded that there exist mechanosensitive intradental A-nerve fibres in the dog which are activated by stimuli that induce fluid flow in dentinal tubules. Nerve fibres of this type could be responsible for dentine sensitivity in man. Consequently, the present study gives support to the hydrodynamic hypothesis of dentine sensitivity. Moreover, mechanosensitive nerve fibres could also be responsible for the pain symptoms of pulpal inflammation, because pulpitis may also create suitable circumstances for their activation.

Increased levels of Met-enkephalin-like material in the CSF of anaesthetized cats after tooth pulp stimulation

Tooth pulp stimulation in halothane-anaesthetized cats induced a long lasting (greater than or equal to 3 h) increase in the levels of Met-enkephalin-like material (MELM) in the cisternal CSF. Chromatographic analyses (gel filtration, HPLC) revealed that most of the immunoreactivity was attributable to high molecular weight (mol. wt. greater than or equal to 4000) compounds; in non-stimulated cats, Met-enkephalin (largely in the form of the sulfoxide derivative) only accounted for about 10% of total MELM. In contrast, following tooth pulp stimulation, a large increase in Met-enkephalin (plus Met-Ox5-enkephalin) levels was noted so that the pentapeptide thus represented more than 50% of total MELM. No evidence was obtained for the presence of Met-enkephalin-Arg6-Phe7 in the cisternal CSF of halothane-anaesthetized cats. These data strongly suggest that the activity of enkephalinergic neurons was increased following nociceptive stimulation. This indirectly supports the possible physiological role of enkephalinergic systems in modulating nociceptive inputs.

The effects of sympathetic trunk stimulation on the position and mobility of the canine tooth of the cat

The effects of cervical sympathetic trunk stimulation on the position of the maxillary canine tooth and its movements in response to mechanical loading were studied using an ultrasonic transit time technique. Stimulation of the ipsilateral sympathetic trunk for 10-60s and frequencies between 1 and 20 Hz caused both longitudinal and transverse movements of the tooth. Bilateral carotid occlusion caused negligible movements in either direction. When a controlled force was applied in the palatal direction, sympathetic stimulation caused a labial shift of the tip of the tooth and usually an increase in the load-induced palatal displacement; i.e. the mobility of the tooth was increased and appeared to be dependent on the amount of labial shift of the tooth. It is concluded that interference with the vascular component has little, if any, direct effect on the tooth mobility.

A fine-structural investigation on the extent of perineurial investment of the nerve supply to the pulp in rat molar teeth

The fine structure of the tissues immediately adjacent to nerve fibres supplying the rat molar pulp has been examined and compared with that of perineurium of other peripheral nerves. In the periapical region, almost all nerve fibres were invested with typical perineurium; only a few Schwann cell units (unmyelinated axons) lacked perineurium. In the pulp at the apex of the distal root, most fibres were invested by less typical perineurium but some were not invested at all. In the pulp at the coronal end of the root, nerve fibres were completely invested or incompletely invested with attenuated perineurium or lacked investment altogether. In the coronal pulp, there was virtually no perineurium at all. Thus rat molar pulp nerve fibres lack perineurium for distances of about 0.5-3.0 mm, distances greater than in situations such as skin or muscle. In normal peripheral nerves, the perineurium behaves as a barrier to the passage of substances from the immediate environment of the nerve fibres (endoneurium) to the surrounding environment (epineurium) and vice versa. Its absence around pulp nerve fibres raises questions about the nature of the pulp environment and may help to explain the sensitivity of pulp nerves to chemical, osmotic and other stimuli.

Autoradiographic demonstration of ipsilateral and contralateral sensory nerve endings in cat dentin, pulp, and periodontium

In order to determine the location of sensory nerve ending in cat teeth, 3H-proline and 3H-leucine were injected into the left trigeminal ganglion of eight cats aged 6.5-10 months; 24 hours was allowed for axonal transport of radioactive protein to dental nerve endings, and the endings were then detected by autoradiography. The pulps of most ipsilateral (left) teeth contained some labeled axons. These axons ended in the odontoblastic layer and predentin of roots and crown; at the tip of the pulp horn of each cusp, nerve endings also extended as far as 150 micrometer into dentinal tubules. Labeled nerve endings were extremely rare in contralateral (right) teeth; only one tooth of 83 studied (eight cats) contained heavily labeled axons, and one other had faintly labeled axons. Both labeled contralateral teeth were central maxillary incisors. Their labeled axons were unbranched in the root and arborized in the crown to end among odontoblasts and many adjacent dentinal tubules. Labeled periodontal nerve endings were most numerous in the apical one-third of the ligament, with some endings extending as far as the gingiva. The nerve endings in the periodontal ligament were often clustered and appeared to end freely between the collagen bundles; their radioactivity varied in the same way as that of pulp nerves in the adjacent root.

Inhibitory actions produced by local electrical stimulation in the caudal spinal trigeminal nucleus in rat

Inhibitory actions induced by local electrical stimulation (LES) on the tooth pulpal afferent activities were investigated in the caudal part of the rat spinal trigeminal nucleus. For the LES, ipsilateral Yin-Hsiang (intrasegmental point) or Ho-Ku (extrasegmental point) was used as a cathodal point which was stimulated electrically by a single pulse of 0.1 msec in duration or by 0.1 msec-pulse train at 45 Hz for 15 min. We found at least three types of inhibitions in the caudal trigeminal nucleus: Type I--this inhibition is the most forceful, caused by naloxone-reversible endogenous opiate system with a slow onset and prolonged aftereffect. This inhibition is presumably postsynaptic action. Type II--this is evoked by postsynaptical acting inhibition and begins within milliseconds after the stimulus is applied. Type III--this inhibition is elicited by presynaptic action and also begins within milliseconds after the onset of the stimulation. Type I and II inhibitions are evoked by stimulating either intra- or extrasegmental LES points, however, Type III is produced by stimulation of intrasegmental and rarely provoked by extrasegmental point stimulation. Naloxone failed to reverse Type II and III inhibitions. During LES, Type I to III inhibitions co-work for producing the suppressive effect and after the cessation of its stimulation, only Type I inhibition produces the so-called aftereffect of the LES.

Tooth pulp input to the spinal trigeminal nucleus: a comparison of inhibitions following segmental and raphe magnus stimulation

In rats and cats anaesthetized with urethane a comparison was made of the inhibitory effects of raphe magnus (NRM) and segmental (facial skin) stimulation on neurones in nucleus caudalis excited by tooth pulp stimulation. The upper and lower ipsilateral incisor teeth were used in rats (176 neurones) and the corresponding canine teeth in cats (34 neurones). The recording sites were located in all layers of nucleus caudalis and in the underlying reticular formation. Both the evoked responses and the conditioning effects were similar in the two species. Both forms of conditioning inhibited about half the neurones tested but only as small proportion was influenced from both sources. NRM stimulation had almost identical effects on neurones driven from upper teeth or from lower teeth and tended to act on those cells with longer latencies. Segmental stimulation influenced the majority of shorter latency cells and produced greater inhibitions of upper tooth pulp neurones. Diffuse noxious inhibitory controls were also observed for certain neurones.

The effects of desensitizing agents on the hydraulic conductance of human dentin in vitro

The hydrodynamic theory of dentin sensitivity states that a stimulus applied at the orifice of exposed dentinal tubules causes movement of tubular fluid which stimulates nerve receptors. The fluid should obey principles of fluid movement through capillary tubes. Any decrease in the functional radius of the dentinal tubules should greatly reduce the rate of fluid flow, thus reducing dentinal sensitivity. The purpose of this study was to evaluate the ability of agents that have been used previously for clinical dentin desensitization to reduce the rate of fluid flow through dentin in vitro. Dentin discs prepared from extracted human third molars were treated with 50% citric acid to remove debris from tubular orifices. After placing the discs in a split chamber device, the rate at which buffer solution could filter across the dentin under 240 cm of water pressure was measured. The occlusal side of the disc was then treated with an agent thought to desensitize dentin to determine if it reduced fluid flow rate. Discs that had more than a 50% reduction in flow rate were examined by scanning electron microscopy to determine if those agents that decreased fluid flow also partially occluded tubular orifices. This in vitro model provided a useful quantitative method for screening a host of preparations that have been used in the past to decrease dentin sensitivity.

Masseter inhibitory periods and sensations evoked by electrical tooth pulp stimulation

The masseter inhibitory period and sensations evoked by electrical tooth pulp stimulation were assessed in 30 human subjects. Five intensities of electrical stimuli, producing sensations varying from below sensory detection threshold to suprathreshold pain, were applied to upper central incisors. At each stimulus intensity a train of 30, 1-msec, cathodal pulses with an interpulse interval of 2 sec was applied. The averaged masseter activity evoked by the 30 pulses at a fixed stimulus intensity was compared to the quality of the sensation elicited. The threshold for the masseter inhibitory period coincided approximately with an individual's detection threshold for the tooth pulp stimulation. Three configurations of masseter inhibitory periods (single, double and merged) were produced by different stimulus intensities. However, no particular configuration was associated unequivocally with pain sensation. Increases in stimulus intensity evoked changes both in the configuration of the masseter inhibitory period and in the quality of the sensation produced. Chi square analyses showed significant, but progressively weaker, associations between: (1) masseter inhibitory period configuration and stimulus intensity; (2) quality of sensation and stimulus intensity; and (3) quality of sensation and masseter inhibitory period configuration. The weakness of the association between the quality of sensation and masseter inhibitory period configuration also was demonstrated in a double-blind study of the effects of a narcotic analgesic, fentanyl. Although the strengths of non-pain and pain sensations were reduced significantly after fentanyl, there were no changes in the masseter inhibitory periods.

Electroacupuncture suppression of the rat jaw opening response after stimulating the caudal spinal trigeminal nucleus

Suppressive effects of electroacupuncture on the jaw opening responses evoked by stimulation of two areas (anterior and posterior) within the caudal spinal trigeminal nucleus were investigated using lightly anesthetized rats. Electroacupuncture stimulation markedly suppressed the jaw opening responses evoked by stimulating the posterior area, but suppressed only slightly those evoked by stimulating the anterior area.

Further studies on opiate receptors that mediate antinoception: tooth pulp stimulation in the dog

1 The antinociceptive activities of morphine, codeine and dextropropoxyphene (micro-agonists), buprenorphine and Mr 2034 [(-)5,9-dimethyl-2-(tetrahydrofurfuryl)-2'-hydroxy-6,7-benzomorphan](k-agonists ) have been determined against nociceptive responses to electrical stimulation of the tooth pulp in the conscious dog. 2 Dose-dependent increases in nociceptive threshold were obtained for all of the analgesic drugs tested at doses within their antinociceptive range as determined in nociceptive pressure and chemical tests in rodents.

Elevation of pain threshold to tooth shock by brain stimulation in primates

Electrical stimulation of the brain (ESB) for modulation of pain has been previously demonstrated in primates, but many of the sites which yield stimulation-produced analgesia (SPA) also elicit aversive side effects. In order to examine the aversive as well as analgesic effects of brain stimulation, nine rhesus monkeys (Macaca mulatta) were first trained to press a lever to escape or titrate noxious tooth shock. Stimulating electrodes were placed under the frontal cortex in 4 monkeys and were implanted in the diencephalon, brain stem, and cerebellum of five remaining monkeys. Diencephalic stimulation sites resulted in marked elevations of tooth shock threshold at ESB intensities which did not elicit aversive behaviors. The analgesic effects lasted up to 2 h past ESB offset. Moderate elevations of tooth shock threshold were also observed with orbital cortex stimulation. The midbrain central gray and the nucleus raphe magnus, however, did not greatly alter tooth shock level and typically resulted in aversive reactions. The diencephalic sites which elicited SPA also led to self-stimulation behavior, whereas stimulation of the brain stem or cerebellum usually resulted in escape responses. These findings thus indicate that, in primates, more effective relief of pain can be achieved with electrical activation of the medial diencephalon than with brain stem stimulation.

Sensory differences between crown and root dentin in human teeth

Earlier ultrastructural investigations of human teeth have revealed differences in the innervation between crown and root dentin. In the present investigation, an intradental comparison of human teeth was made to estimate the sensitivity to different stimuli applied to two cavities, one in the buccal cusp and the other half-way between the cervix and the apex of the tooth. It was found that the pain produced by the different stimuli in the cuspal cavity was described as "sharp" or shooting, while the same stimuli applied to the root cavity provoked "dull" pain, often of a longer duration. Gentle stimuli, such as dry absorbent paper, only produced pain in the cuspal cavities. Ultrastructural examination revealed no nervous elements in the vicinity of the ground surface of the tested cavities in the crown or in the root. Odontoblastic cells including nuclei, were a common finding in the dentinal tubules of both the roots and the cusps, indicating aspiration of these cells. In some cases, in the cuspal areas, accompanying nerve-fibres had also been aspirated. The conclusion of the present investigation is that there are differences in sensibility between crown and root dentin. These differences are observed in both intensity and modality, supporting earlier findings of morphological discrepancies in the innervation of the coronal and root dentin.

The absence of proprioceptive nerve endings in the human periodontal ligament: the role of periodontal mechanoreceptors in the reflex control of mastication

A review of the literature was conducted to determine the presence or absence of proprioceptive nerve endings in the human periodontal ligament. A histologic review of the periodontal ligament innervation concluded that nerve endings found were those mediating pain, pressure, or touch and that there is no histologic evidence of any "classic" proprioceptive nerve ending in the periodontal ligament. A summary is given concerning the precise role of nerve endings in the periodontal membrane, their afferent pathways, and the role of masticatory muscle proprioception, jaw reflexes, and the temporomandibular joint in the coordinated control of mastication and mandibular proprioception.

Relative cerebral glucose metabolism evoked by dental-pulp stimulation in the rat

Electrical stimulation of dental pulp is widely acknowledged to produce a sensation that is predominantly or exclusively noxious in character. The authors report the pattern of local cerebral glucose utilization evoked by dental-pulp stimulation in the barbiturate-anesthetized rat, using the [14C]2-deoxyglucose method of Sokoloff. Autoradiographs were prepared from cryostat-cut brain sections of animals given an intravenous pulse of [14C]2-deoxyglucose and sacrificed after 45 minutes of continuous bipolar stimulation of the incisor tooth pulp. Areas of high optical density on the autoradiographs identified brain regions where glucose consumption, and hence functional activity, was maximal. Stimulus-related increases in glucose utilization were seen ipsilaterally in an uninterrupted column from the lower levels of trigeminal nucleus caudalis to the rostral extent of the main sensory nucleus. Mandibular incisor pulp stimulation yielded increased deoxyglucose uptake in relatively restricted dorsal portions of the nuclei, while maxillary pulp stimulation produced a more extensive area of uptake ventrally. Elevated deoxyglucose uptake was also seen in the contralateral ventrobasal thalamus and sensory cortex with maxillary, but not mandibular, pulp stimulation. No changes in metabolic activity were detected in extralemniscal or limbic structures. These initial results suggest that the [14C]2-deoxyglucose method may be a useful means of mapping central structures involved in nociception.

Dental dolorimetry for human pain research: methods and apparatus

Electrical stimulation of human tooth pulp provides a means of safely producing human pain in the laboratory. This paper describes a dolorimetry and data collection system for stimulating volunteers, recording responses and analyzing data. The system allows multilevel stimulation in pseudorandom sequences and analysis of results using the methods of Sensory Decision Theory. It consists of modified commercial equipment, specially designed circuitry, an interface, and a programmable calculator. Fundamental problems and safety considerations for electrical dental stimulation are reviewed. Reliability of stimulation and response measurement is discussed.