Sensory mechanisms in mammalian teeth and their supporting structures

Features peculiar to the trigeminal innervation

The aspects of trigemina! sensory structure and function which are uniquely different from spinal systems are reviewed in this paper.

In the periphery, several unique arrangements of sensory receptors are seen, and appear to have unique sensory functions. The receptors in the cornea, the nasal mucosa, and the tooth pulp are morphologically unspecialized and are associated with “protopathic” sensory experiences. The important sensory functions of the mammalian vibrissae are also discussed, as well as their relationship to the anatomically distinctive cortical “barrels”.

Aspects of trigeminal proprioception are also of interest. The absence of spindles in some muscles and the unique central organization of trigeminal proprioceptive afférents in the jaw and extraocular muscles are of functional significance in the motor function of the jaw and the eye.

Trigeminal afférents are also involved in several complex autonomie reflexes. Characteristic changes in cardiovascular and respiratory function are elicited by various patterns of trigeminal sensory stimulation. These reflexes include the diving reflex, the oculo-cardiac reflex, naso-cardiorespira-tory reflexes, and the trigeminal depressor response. The clinical significance of these reflexes is discussed.

Several coordinated behavioral responses including suckling are also elicited from trigeminal afférents. The evidence implicating trigeminal afférents in eating and drinking behavior is presented.

Innervation of different parts of the predentin and dentin in young human premolars

The innervation of the predentin and inner part of the mineralized dentin was studied at the ultrastructural level in ten premolars. Each tooth was divided into fifteen different parts, each containing odontoblasts, predentin and dentin. It was found that the innervation in the coronal dentin was more compact than in the root dentin. Within the coronal dentin itself, the most densely innervated area was the dentin covering the pulp horns. No nerves were identified more than 100 microns from the pulp-dentinal border. No nervous structures were found in the mineralized dentin of the root. Nervous structures which seemed to have no connection with the odontoblastic processes were frequently observed in the predentin of the root. Signs of degeneration of the nervous structures of the predentin of the root was also a common finding. The observation that the intradentinal nerves were confined to the predentin and the most pulpal part of the dentin supports the theory that surface stimulation on dentin has an indirect effect on the nerves activated by movements in the liquid of the dentinal tubules.

The effects of stimulation of trigeminal sensory afferents upon caudate units in cats

This investigation assessed the influences of trigeminal primary sensory afferents upon caudate neuronal activity in locally anesthetized and chloralose anesthetized cats. Afferents from jaw elevator stretch receptors were stimulated via electrodes in the trigeminal mesencephalic nucleus (Mes 5). Afferents from dental and periodontal receptors were stimulated via electrodes in the inferior dental nerve (IDN). Low intensity electrical stimulation of either locus evoked caudate neuronal responses with Mes 5 being more effective. Higher intensity stimulation of IDN in chloralose anesthetized cats was used to determine if thresholds of trigeminal evoked caudate responses corresponded to thresholds of particular fiber groups in the sensory afferent. In all tested units, neuronal responses were only evoked when stimulation was suprathreshold for both A beta and A delta fibers. These data were discussed in relation to processing of oropharyngeal sensory information within the basal ganglia. Possible implications for bucco-lingual dyskinesias were noted.

Properties of intraoral mechanoreceptors represented in the mesencephalic nucleus of the fifth nerve in the cat

1. The activity of neurones in the mesencephalic nucleus of the fifth nerve that respond to forces applied to the teeth were recorded using extracellular microelectrodes; the properties of these neurones have been studied. 2. Electrophysiological evidence consistent with the view that primary afferent intraoral mechanoreceptor fibres have their cell bodies in the trigeminal mesencephalic nucleus is presented. 3. Two groups of intraoral mechanoreceptor neurones were found. The first group, the periodontal mechanoreceptor neurones, which have been described by previous workers, responded to electrical stimulation of the ipsilateral superior or inferior dental nerves and to forces applied to single teeth in the ipsilateral maxilla or mandible respectively. The response characteristics of the mesencephalic periodontal mechanoreceptor neurones differed in two respects from those observed in peripheral nerve studies by previous workers: (a) there were no spontaneously active neurones, and (b) there were no neurones that responded for over 10 sec to a sustained application of a suprathreshold mechanical stimulus to the teeth. The second group, not described before, responded to electrical stimulation of the ipsilateral palatine nerve, and responded to forces applied to all the teeth in the maxillary arch, both contralateral and ipsilateral as well as to forces applied to the nose and hard palate. The site of these receptors is unknown. They have been termed 'Type P' intraoral mechanoreceptors. 4. The recording sites of both the periodontal and Type P mechanoreceptor neurones were all situated in the caudal part of the mesencephalic nucleus of the fifth nerve.

Clinical comparison of masticatory performance and electromyographic activity of patients with complete dentures, overdentures, and natural teeth

In this study, which is the first of its kind, it has been shown that overdenture patients, when compared to complete denture patients, while chewing a test food for a constant number of strokes, expended an equivalent amount of muscle effort, chewed more slowly and efficiently, and evidenced significantly better masticatory performance by producing an increased volume of fine test food particles. These findings provide a sound justification for the extra effort required to retain some natural teeth to provide overdenture services to patients. The fact that patients can masticate food more efficiently with overdentures than with complete dentures justifies the increased cost and time involved in their construction. The longitudinal effects that overdentures have on the basic physiopathologic processed involved in the progression of ridge resorption and the advantages of maintaining periodontal proprioception also should be studied.

Localization of substance P-like immunoreactivity in nerves in the tooth pulp

The occurrence of substance P (SP)-like immunoreactivity was studied in dental pulps of the cat. In untreated animals SP-positive fibres were found in all areas of the pulp. Most fibres were seen in central parts of the pulp but they were also observed in relation to the odontoblasts. Single, possibly unmyelinated, or fine caliber fibres or small bundles of them were seen running close to large non-fluorescent myelinated nerves, to blood vessels or without any obvious association with either of these structures. Fourteen days after transection of the inferior alveolar nerve no SP-positive fibres were observed in pulps on the denervated side. Transection of the cervical sympathetic ganglion did not change the occurrence of SP-positive fibres. The results indicate the existence of at least two types of afferent fibres in the dental pulp of the cat. Since the tooth pulp has been demonstrated to give rise only to pain sensation when stimulated, the results give morphological support for a role of SP neurones in pain transmission.

Sensation evoked by bipolar intrapulpal stimulation in man

Bipolar intrapulpal stimulation was applied to human teeth using the same procedure as in animal experiments. The effects of variation of stimulus parameters on the quality of sensation were studied. A prepain sensation exists which cannot be explained by diffusion of the stimulus to periodontal tissues. When the intensity of stimulation is increased, the prepain sensation is gradually replaced by a pinprick sensation. With long, high intensity stimulation, an acute long lasting very painful sensation appears. To evoke a pinprick sensation the best stimulation seems to be a 50 msec train (0.5 msec, 300 Hz, 0.5 mA). Longer train duration and a higher intensity of current are necessary to evoke a long lasting, acute very painful sensation. Since the exclusively Adelta and C nerve fiber content of the dental pulp is well documented and since it is possible to avoid current diffusion outside the dental pulp cavity, the tooth pulp implantation seems to be a good technic for studying pain, as long as the investigator uses adequate stimulation.

Trigeminal nerve endings in gingiva, junctional epithelium and periodontal ligament of rat molars as demonstrated by autoradiography

Tritiated-L-proline was injected into the right Gasserian ganglion of mature rats for incorporation into proteins being carried by rapid axonal transport to nerve endings. The distribution of the nerve endings in molar gingivae and periodontium was subsequently mapped in serial sections by autoradiography. We found that sensory nerve terminals are most prominent in two regions of the free gingiva: (1) In the junctional epithelium there is a rich innervation of the basal epithelial layer with many endings penetrating several cell layers. (2) In the crestal epithelium arborized endings are present, especially on the marginal side of the crest. In the attached gingiva a few terminals are found in the epithelium with more in the lamina propria; the latter appear to be encapsulated. The periodontal ligament is only moderately labeled with silver grains located over nerve bundles, over nerves associated with blood vessels, and over a few apparent endings in the apical region. In the cementum no labeled endings are seen. Labeling of Gasserian cell bodies primarily reveals specific intra-epithelial nerve endings in gingiva crest and junctional epithelium. The absence of major labeling of the periodontal ligament supports the view that many nerves in that region are derived from cell bodies in the mesencephalic nucleus.

Electron microscopy of degenerating axons and terminals in spinal trigeminal nucleus after tooth pulp extirpations

Following multiple tooth pulp extirpations, electron microscopic preparations show degenerating axons and synaptic terminals in the same region of the brain stem trigeminal nucleus previously demonstrating degeneration by light-optical methods. The observations confirm the phenomenon of transganglionic degeneration in this system and identify the class of central nervous system axons and synapses specifically related to innervation of the teeth.

An autoradiographic study of the sensory innervation of teeth. II. Dental pulp and periodontium

Autoradiography of axoplasmically transported proteins revealed that both dental pulp and periodontium receive sensory innervation from the trigeminal ganglion in the form of plexuses and free and organized sensory receptors, including apparent corpuscular ones. Corpuscular receptors in the pulp suggest this tissue may be responsive to modalities other than pain.

An autoradiographic study of the sensory innervation of teeth. I. Dentin

Autoradiography of axoplasmically transported proteins revealed that the coronal dentin of rat molar teeth receives sensory innervation from the trigeminal ganglion. The labeled processes appear to run in dentinal tubules and sometimes reach the peripheral dentinal region near the enamel.

A new technique for recording of intradental sensory nerve activity in man

A technique was developed to record intradental sensory nerve activity in man. The method involves permanent fixation of electrodes in dentin thus enabling continuous recordings to be made. Acute as well as long term influences on excitability of sensory nerve endings in the tooth can thus be studied. A coincidence between recorded spike activity and pain sensation was observed.

Changes in the fine structure of the human dental pulp subsequent to carious exposure

Sections of human pulp tissue taken from the region of a carious exposure in four young patients each having a clinical history of spontaneous dental pain were examined with the electron microscope. All the tissues examined exhibited a generalized edema, and an infiltration with lymphocytes, plasma cells, polymorphonuclear leukocytes and macrophages. Varying degree of lysis of pulp and inflammatory cells were evident. The unmyelinated nerve axons of the pulp appeared to be least affected. Extracellular lysosomes were present in many of the necrotic areas. Edematous vacuoles were noted in two of the pulp specimens. In some of the sections these vacuoles appeared to be responsible for a physical distortion of adjacent unmyelinated nerve axons. It was postulated that such distortion may be a contributing factor to the pain of pulpitis. In another of the pulp specimens, micro-organisms were found intracellularly and extracellularly. Intracellularly they were present within the cytoplasm of polymorphonuclear leukocytes and macrophages and exhibited evidence of lysis. Only two morphological forms, a gram positive rod, and a gram positive coccus were identified.

Responses of intradental nerves to electrical and thermal stimulation of teeth in dogs

1. Experiments were carried out to investigate the mechanism whereby thermal stimul excite nerves to produce pain from teeth. 2. Recordings have been made from single fibres dissected from the inferior dental nerve in dogs during thermal stimulation of the lower canine tooth. 3. In preliminary experiments, no units were found with thresholds close to the thresholds for pain in man (45 and 27 degrees C) and subsequently test stimuli of 55 degrees C, applied for up to 15 sec, and 0-5 degrees C were used. 4. Of 117 fibres tested, forty-three responded to cooling but not to heating and nine responded to heating but not to cooling. 5. By applying thermal stimuli direct to the saphenous nerve in cats, it was shown that these responses might have been due to direct excitation of nerves and not to stimulation of specialized receptors. 6. Some units responded to electrical stimulation of the tooth pulp with a latency which decreased abruptly at a critical intensity as the stimulus was increased above threshold. Evidence was obtained which suggested that this was due to branching of the fibres.

Inputs to trigeminal brain stem neurones from facial, oral, tooth pulp and pharyngolaryngeal tissues: I. Responses to innocuous and noxious stimuli

Responses evoked in anaesthetized or decerebrate cats by stimulation of afferents supplying the face, mouth, pharynx, larynx, tooth pulp and jaw muscles were recorded from single neurones located in the trigeminal (V) main sensory nucleus, V nucleus oralis, and adjacent regions. Many cells (both V-thalamic relay and non-relay with localized V mechanoreceptive cutaneous fields could be activated by stimulation of a number of these afferents. A particularly prominent short-latency (often monosynaptic) input was noted from the canine tooth pulp, stimulation of which is generally considered to elicit only responses of pain in man. Control experiments showed that pulp-evoked responses were not the result of stimulus spread to tissues outside the pulp. The interaction of these various inputs to neurones at this level of the V brain stem complex typically resulted in a prolonged period of inhibition that was sometimes preceded by a short-lasting facilitatory phase. This inhibitory effect was also apparent in neurones located outside the complex, although a late facilitatory phase was frequently also noted. Our findings indicate a significant nociceptive input to V main sensory-oralis neurones, a proportion of which relay directly to the ventrobasal thalamus. The interactions described may be involved in perceptual and reflex aspects of responses to noxious and innocuous V stimuli.

Bilateral projection of the canine tooth pulp to bulbar trigeminal neurons

Unit activity was recorded extracellulary from neurons of the cat medulla following electrical stimulation of the ipsilateral and/or contralateral cannine tooth pulps. The majority of the cells (67%) were only responsive to ipsilateral stimulation. However, many (28%) responded to stimulation of either canine pulp and a few (5%) responsed to contralateral stimulation alone. The neurons were localized histologically in the necleus proprius of the rostral trigeminal nucleus caudalis (NVCaud) and in dorsal portions of the ventromedially contiguous lateral reticular formation (LRF). Cells exclusively responsive to ipsilateral stimuli had a relatively wide dorsoventral distribution. In contrast, 'bilateral' and 'contralateral' cells were situated only in the deep NVCaud-LRF border zone or in immediately adjacent portions of the LRF. Generally, ipsilateral stimuli evoked response bursts with shorter latencies, more spike potentials and briefer interspike intervals than equivalent contralateral stimuli. In experiments designed to study afferent interactions, a conditioning stimulus, applied to either the ipsilateral or the contralateral canine, preceded a test stimulus applied to the other canine at predetermined interstimulus intervals. Responses to the test stimulus were either totally or partially suppressed when intervals of moderate duration (90-500 msec) were used. However, responses to the test stimulus frequently were enhanced when the intervals were breif (less than or equal to 60 msec) or when the teeth were stimulated simultaneously. The results reveal that bilateral afferents from the pulps of the canine teeth converge upon neurons of bulbar trigeminal structures, that the neurons are differentially responsive to the activation of ipsilateral and contralateral pulpal receptors and that bilateral afferent barrages originating in the canine pulps interact to modulate the firing patterns of the neurons.

Sensory and reflex responses to tooth pulp stimulation in man

Experiments have been carried out to investigate whether all tooth pulp afferent nerves are capable of producing pain. Monopolar and bipolar stimuli were applied to teeth in human subjects and sensory thresholds determined. EMGs were recorded from the masseter and the anterior digastric muscles. With stimuli up to three times the sensory threshold, no response could be detected in the digastric but at, or just above, the sensory threshold, inhibitory effects were produced in masseter muscle. The latency of the muscle response with bipolar stimulation was 18-22 msec. There was no evidence of stimulus spread to nerves outside the teeth. Bipolar and monopolar stimulation both produced the same sensation but this was not described as painful. It is concluded that some pulpal afferent nerves may not be capable of producing pain, and that the sensory and reflex responses at threshold were probably produced by the same fibres.

Responses of intradental nerves to chemical and osmotic stimulation of dentine in the cat

Recordings have been made of the neural responses evoked by stimulation of dentine with solutions of NaCl, NH4Cl and dextrose. Stimulation of the outer dentine produced no response. From the inner dentine, a smaller number of impulses were recorded with solutions of NaCl than with corresponding concentrations of NH4Cl, but a much larger number than with solutions of dextrose. The discharge evoked by a solution increased in mean frequency and decreased in latency as the thickness of dentine was reduced. The responses suggest that the receptors were in the innermost dentine or the pulp and that they were excited by changes in extracellular fluid composition rather than by osmotic effects. The properties of the receptors appear to be different from those involved in pain from dentine in man.

Electrical stimulation of the tooth pulp in the study of pain

Unit activity was recorded from bulbar neurons in the immobilized, lightly anesthetized cat following bipolar, electrical stimulation of the canine tooth pulp and the immediately proximal gingiva. When feasable, variations in neuronal responding were studied subsequent to the application of a topical anesthetic to the portion of the gingiva being stimulated. The results indicate that (1) stimulation of the pulp with insulated, embedded, dental electrodes does not excite receptors in adjacent, nondental tissue and (2) stimulation of the gingiva through insulated, concentric electrodes does not activate pulpal receptors in near-by teeth. In addition, the results corroborate previous demonstrations that current spread beyond the pulpal cavity is unlikely when appropriate stimulating procedures are used. Together, the data lend support to the position that electrical stimulation of the tooth pulp provides a unique means for the selective, parametric study of a known pain sensor.

Response patterns to noxious and non-noxious stimuli in rostral trigeminal relay nuclei

Postimulus time histogram analysis of second-order neuron responses in rostral trigeminal relay nuclei of cat demonstrated characteristic firing patterns after noxious (tooth pulp) and non-noxious (tooth tap) stimuli. The response to noxious stimulation was prolonged and frequently bimodal while the response to non-noxious stimulation was brief. The same neurons were fired by electrical stimuli applied directly to nucleus caudalis but with longer latencies suggesting a contributory role of nucleus caudalis to the characteristic prolonged bimodal response pattern to noxious stimuli. Interacting noxious and non-noxious stimuli using condition-test sequences demonstrated further stimulus mode-related changes in firing patterns. Electrical conditioning stimuli in nucleus caudalis reduced some responses while strychnine sulfate applied into nucleus caudalis augmented the responses evoked in rostral nuclei by both noxious and non-noxious peripheral stimuli. Nucleus caudalis appeared to contain elements which may modulate activity in rostral trigeminal nuclei by either augmenting or reducing specific firing patterns of second-order neurons in rostral relay nuclei.

Projection of tooth pulp afferents to the cat trigeminal nucleus caudalis

Unit activity was recorded extracellularly from cat medullary neurons following electrical stimulation of the canine tooth pulp. Response characteristics of the neurons quickly stabilized at specific suprathreshold stimulus intensities but such properties as spike latency, interspike interval and spike density varied systematically as intensity was raised to maximally effective values. Receptive fields were principally unilateral. The majority included both canines and extended into other oro-facial areas. Suppression of a pulpal response could be effected by preceding tooth stimulation with a conditioning stimulus applied to some other point in the receptive field of the responding cell at an appropriate interstimulus interval. In contrast, a pulpal response could be enhanced by presenting two stimuli successively to the same canine at such intervals. Similar enhancing effects followed simultaneous stimulation of spatially segregated loci in a field. The pulp-responsive neurons were localized histologically in, or in the immediate vicinity of, the nucleus caudalis of the spinal trigeminal complex where the possibility of their existence has been questioned previously. Most of the cells were situated along the ventromedial border of the nucleus, a region reported to contain other pain-related neurons with trigeminal fields.

[A microphysiologic study of thalamic projection of the cat's dental pulp (author's transl)]

(1) A similar proportion of cells in the VPM (24.7%), MGmc (24%), CM (26.8%) and CL (28.6%) is activated by electrical stimulation of the cat's dental pulp. However the thresholds are very different, cells belonging to the first group of the VPM being often activated by stimulation below 0.1 V. (2) Pain seems to be the unique sensation evoked by pulpal stimulation. A first group of cells somatotopically localized in the VPM displays a primary type of response. These cells can also be activated from an oral or perioral field. This fact is reminiscent of referred pain phenomenon often encountered in the clinic. (3) A second group of cells scattered in the VPM and activated by pulpal stimulation displays a non-primary type of response. (4) Strong pinching of the skin activates some MGmc cells tonically. Response characteristics of the MGmc cells after pulpal stimulation are heterogeneojs. (5) CM cells activated by pulpal stimulation display long latency responses whose properties are similar to those obtained after somatic stimulation. However, the latency of responses are shorter after limb stimulation than after pulpal stimulation.

Climbing fibre inputs to cerebellar Purkinje cells from trigeminal cutaneous afferents and the SI face area of the cerebral cortex in the cat

1. An investigation was made of climbing fibre (CF) activity evoked in single Purkinje cells in the cerebellum by electrical stimulation of trigeminal cutaneous afferents, the face area of the SI cortex, and the superficial radial nerve, in Nembutal-anaesthetized cats. In addition, both the extent of the cutaneous receptive fields of individual Purkinje cells on the face and the CF responses evoked in these cells by controlled natural stimulation were examined. 2. The pattern of convergence from these inputs on to individual Purkinje cells was found to be complex. DF responses were evoked in 67% of trigeminally-activated cells by electrical stimulation of more than one trigeminal branch. An excitatory CF convergence from the face area of the SI cortex was found on 68% of trigeminally activated cells; 23% also responded to stimulation of the superficial radial nerve. 3. In 81% of the Purkinje cells which were activated by trigeminal nerve stimulation, CF responses were readily elicited by gentle mechanical stimulation of the facial skin. A qualitative relationship was established between the size of the peripheral field of a Purkinje cell, and the probability of convergence on to that cell from the SI cortex. 4. Recordings were made from a limited number of Purkinje cells which were responsive to electrical stimulation of bilateral trigeminal branches and the superficial radial nerve. However, CF responses in these cells often could be elicited only by high intensity stimulation. It is suggested that these cells are analogous to, or perhaps an extension of the population of Purkinje cells described in the anterior lobe which are excited via the ventral funiculus pathway in the spinal cord only by stimulation of 'flexor reflex afferents' in bilateral limb nerves.

Evidence on the origin of impulses recorded from dentine in the cat

1. Recordings have been made from dentine at the tip of the canine teeth of cats using a large Ag/AgCl electrode.2. All-or-none action potentials with complex shapes were recorded when single nerve fibres from the dental pulp were stimulated electrically outside the tooth.3. The wave forms of these action potentials changed when the stimulation rate was increased from 1/sec to 10/sec, when the temperature of the tooth surface was changed between 17 and 42 degrees C, when the thickness of the dentine was reduced, and when local anaesthetic was applied to the dentine. Only a small, monophasic, positive potential remained after transection of the pulp in the crown of the tooth.4. The latency of the action potentials was not affected by these same procedures.5. It is suggested that each wave form represented a compound action potential produced by impulses invading the main branches and terminals of a single nerve in the pulp. Some of the terminals may have penetrated the innermost layers of the dentine.6. There was no spontaneous discharge from pulpal nerves.7. A discharge of impulses was recorded from dentine when 2.5 mol/l. NaCl was applied beneath the electrode at the tip of the tooth. By recording simultaneously from dentine and from single fibres from the tooth pulp, it was shown that impulses recorded from dentine were associated with propagated nerve action potentials.

Contribution of periodontal receptors to the masseteric silent period

Quadrant local anesthesia was sequentially administered to the maxillary and mandibular teeth and periodontium in three healthy individuals. After anesthesia the duration of the silent period was shortened. Total anesthesia of all quadrants abolished the silent period in every individual, demonstrating that sensory impulses from periodontal receptors provide a major source of inhibition, and disfacilitation or active inhibition from intact muscle receptors is insufficient to produce a silent period.