Fluid flow through human dentine

The anatomy, neurophysiology, and cellular mechanisms of intradental sensation

Somatosensory innervation of the oral cavity enables the detection of a range of environmental stimuli including minute and noxious mechanical forces. The trigeminal sensory neurons underlie sensation originating from the tooth. Prior work has provided important physiological and molecular characterization of dental pulp sensory innervation. Clinical dental experiences have informed our conception of the consequence of activating these neurons. However, the biological role of sensory innervation within the tooth is yet to be defined. Recent transcriptomic data, combined with mouse genetic tools, have the capacity to provide important cell-type resolution for the physiological and behavioral function of pulp-innervating sensory neurons. Importantly, these tools can be applied to determine the neuronal origin of acute dental pain that coincides with tooth damage as well as pain stemming from tissue inflammation (i.e., pulpitis) toward developing treatment strategies aimed at relieving these distinct forms of pain.

Evaluation of Five Different Desensitizers: A Comparative Dentin Permeability and SEM Investigation In Vitro

BACKGROUND/OBJECTIVE

The purpose of this study was to evaluate the efficacy and durability of five different dentin desensitizers (Gluma Desensitizer Powergel, Bifluorid 12, Gluma Self Etch Bond, D/Sense Crystal, Nupro Sensodyne Prophylaxis Paste with Novamin) on tubule occlusion and dentin permeability reduction in vitro.

METHOD

The quantitative changes in permeability of 100 dentin discs were measured after desensitizer treatments and following post-treatments of 6% citric acid challenge for 1 min or immersion in artificial saliva for 24 hours under hydrostatic pressure generated by a computerised fluid filtration meter. Qualitative SEM analyses were also carried out.

RESULTS

Dentin permeability decreased after desensitizer application in all groups. Nevertheless, only the difference between 'Gluma Self Etch Bond' and 'Nupro Sensodyne Prophylaxis Paste with Novamin' groups was significantly different (p<0.05). Dentin permeability increased significantly after post-treatments (p<0.05). There was no statistically difference among the citric acid-subgroups (p>0.05). Of all the artificial saliva-subgroups, only the difference between 'D/Sense Crystal' and 'Bifluorid 12' was significantly different (p<0.05). In SEM analysis, morphological changes were detected on the dentin surface and within the tubules following desensitizer treatments and post-treatments.

CONCLUSION

All the desensitizers significantly reduced dentin permeability by changing the morphology of the dentin surface and/or dentinal tubules. Following post-treatments, there was some reduction in the efficacy of the desensitizers which was represented by the reduction in permeability values. SEM analysis revealed some physical changes in the dentin structure which can partly give an explanation to the reduced efficacy of tested desensitizers.

The effect of normal occlusal forces on fluid movement through human dentine in vitro

Receptors inside human incisors appear to respond to stress (comparable to pressure as opposed to force) on the crown. This ability may be used to limit the stress applied to teeth or to discriminate between the hardness of objects clenched between upper and lower teeth. Here the hypothesis that these receptors are activated by fluid squeezed out of dentinal tubules when the loaded tooth is stressed was tested. Vertically compressing the crowns of extracted human teeth with loads of from 20 to 120 N, similar to those used in other studies and during natural chewing, did indeed displace fluid into the pulp. The fluid was displaced away from the crown immediately after the tooth had been loaded and moved back into the crown when the load was removed. The volume ranged from 3.5 to 22.2x10(3) pl, similar to that known to stimulate single pulpal nerve fibres. Thus, normal chewing forces could displace sufficient fluid out of dentine to excite putative mechanoreceptors somewhere inside the dentine/pulp complex.

Microleakage of endodontically treated teeth restored with posts

A fluid filtration system using 15 psi of pressure on the penetrating fluid was used to quantify the amount of microleakage of a stainless-steel post and a carbon-fiber post system, each placed with various cements. Statistical analysis showed that there was a significant difference in microleakage between the cements (p < 0.001). Zinc phosphate cement showed the most microleakage, whereas C & B Metabond cement showed the least. There was no significant difference in microleakage between the stainless-steel and carbon-fiber posts. The results of this study showed that both posts, when cemented with dentin-bonding resin cements (C & B Metabond and Panavia-21), exhibited less microleakage than when cemented with non-dentin-bonding cements (glass ionomer and zinc phosphate).

The effect of pressure on a maximum incisal bite force in man

The maximum bite force an individual can exert on an upper central incisor when the force is transmitted through a point on the incisal edge (no cover) was compared with maximum bite force when distributed over a full acrylic cap (full cover). Eighteen participants rapidly produced a maximum bite force three times each under no-cover and full-cover conditions. The magnitude and direction of the maximum bite force were monitored by a transducer placed between upper and lower incisors. There was no significant change in the direction of the bite force under the two conditions. The average maximum bite force was significantly larger (mean-4.9%, SD-4.6%, p < 0.001) in the full-cover condition. The increase in maximum bite force was attributed to the reduced pressure on the crown under the full-cover condition when compared with the no-cover condition. This implies the existence of mechanoreceptors within the pulp of a tooth because periodontal mechanoreceptors can affect feedback only by monitoring differences in the force on a tooth, not differences in pressure on the crown.

Effect of mechanical removal of the pulp upon the retention of odontoblasts around the pulp chamber of human third molars

The pulp chambers of 11 freshly extracted human third molars were exposed by cutting off the roots apical to the cervical margin and the pulps were either removed with forceps and discarded or left in situ. The teeth were fixed, demineralized, divided longitudinally, embedded in resin and 2-micron sections stained with toluidine blue were examined by light microscopy. In pulp-removed specimens the percentage retention of the odontoblast layer with the predentine varied near the longitudinal division but when sectioned deeper all six specimens displayed 100% retention. The intactness of the retained odontoblast layer was mostly good as judged by the mutual close apposition of the distal ends of the cell bodies and their relation to the predentine. The retention of the odontoblast layer with the predentine may be due to the distribution of fibronectin, which others have shown is present between odontoblasts, and between odontoblasts and predentine, but lacking beneath the odontoblast layer.

Distribution of zinc ions from orthophosphate cements at the cement-tooth interface in fixed dental prosthesis

Cast metal prostheses are considered to be one of the best ways to restore the morphology and function of missing teeth. However, the success of fixed prosthesis therapy is mainly to be judged on its durability. It is therefore important to know how cemented prostheses behave in the mouth. A protocol for an in vivo study was set up to analyse the influence of time on the release of zinc ions from zinc orthophosphate cements used at the tooth-prosthesis interface.

Assessment of pain in cervical dentinal sensitivity studies. A review

Traditionally cervical dentinal sensitivity (CDS) has been evaluated mainly subjectively on the basis of the individual patient's subjective response, e.g., in the form of verbal rating and visual analogue scales and questionnaires. The stimuli used for evaluating this response can be grouped into 4 main categories: mechanical, chemical, electrical and thermal. This review of the literature, however, indicates that there are problems in evaluating patient subjective response to these various test stimuli used in the assessment and treatment of CDS. Opinions also vary as to the reliability of some of these methods of assessment, although recently, efforts have been made to develop controlled reproducible stimuli more suited to the evaluation of CDS. Currently no single method of eliciting and assessing CDS may be considered ideal. Further research is required to evaluate suitable methodology for the quantification of realistic test stimuli under controlled clinical conditions, whereby the subjective response may be objectively measured by the investigator.

Fluid flow through cat dentine in vivo

An outward flow of fluid through exposed dentine was demonstrated in anaesthetized cats. The flow was measured by observing the movement of the fat droplets of dilute milk in a glass capillary (i.d. 30 microns) with a microscope. The capillary was sealed to the dentine with a plastic cap. The resting flow rate through dentine exposed by fracturing off the tip of a cat's canine ranged from 2.8 to 50.9 pl.s-1.mm-2 (mean 18.1, SD 15.9, n = 12). Raising the pressure at the dentine surface to about 15 cmH2O stopped the flow. Immediately after cutting the pulp at the root apex, in 11 of 12 preparations, the flow reversed. The average flow rate was then 3.8 pl.s-1.mm-2 inward (range 8.4 outward to 15.9 inward, SD 5.4, n = 12). The inward flow after pulp section suggests that an osmotic effect may contribute to the net pressure causing flow. The average hydraulic conductance of the exposed dentine was 1.6 x 10(-8) m.s-1.kPa-1 (range 0.5-2.9, SD 0.8) before pulp section. After pulp section, it increased to an average of 2.5 x 10(-8) m.s-1.kPa-1 (range 0.8-5.2, SD 1.3).

Effects of distance from the pulp and thickness on the hydraulic conductance of human radicular dentin

The purposes of this study were: (1) to measure the effect of distance from the pulp on the hydraulic conductance of human radicular dentin; (2) to determine the influence of dentin thickness on the rates of fluid flow; and (3) to attempt to correlate dentinal tubule densities and diameters with root dentin hydraulic conductance. Dentin slabs prepared from extracted, unerupted, human third molar teeth were placed in a split-chamber device to permit quantitation of fluid filtration rate (hydraulic conductance). In the SEM portion of the study, dentinal tubule numbers and diameters were recorded. The results indicated that radicular dentin hydraulic conductance decreased with distance from the pulp and with increasing dentin thickness. Tubule density and diameter correlated well with the measured hydraulic conductances. The relatively low hydraulic conductance of outer root dentin makes it a significant barrier to fluid movement across root structure.

The ultrastructure of dentinal tubules from erupted human premolar teeth

Different regions of crown dentin from erupted human premolars were examined ultrastructurally to determine the contents of the dentinal tubules. Odontoblast processes were limited to inner dentin, and nerve fibers were not observed in any tubules examined.

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.

The extent of the odontoblast process in human dentin

Impacted human third molar teeth were examined, both with the light and electron microscope, to determine the extent of the odontoblast process. The odontoblast process was found to be limited to the inner third of coronal dentin and inner half of mid-root dentin.

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.

Dentin permeability: determinants of hydraulic conductance

A technique is described which permits measurements of the ease with which fluid permeates dentin. This value, the hydraulic conductance of dentin, increased as surface area increases and/or as dentin thickness decreases. It increased 32-fold when dentin was acid etched due to removal of surface debris occluding the tubules.

The sensory mechanism in human dentin as revealed by evaporation and mechanical removal of dentin

Dentinal pain in connection with mechanical stimulation i.e. probing, chiseling and initial drilling may be due to removal of fluid from the dentinal tubules. Loss of fluid due to "normal" evaporation from exposed dentin may produce an outward flow in the dentinal tubules rapid enough to cause pain and within a few minutes odontoblast aspiration.

Dentin permeation: comparison of diffusion with filtration

A comparison was made between the rate of iodide permeation of dentin by diffusion and by filtration. Before acid etching, filtration only doubled the rate of iodide permeation relative to that obtained by diffusion. After acid etching, filtration produced a 32-fold increase in permeation. Acid etching, by removing occluding debris, facilitates filtration more than diffusion.

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.

Effects of acid etchants on dentin

The ability of acid etchants to penetrate dentin was tested under simulated clinical conditions. No penetration of the dentinal tubules by acid was detected by use of two different test methods, although pronounced roughening of the treated surfaces was observed.