Biphasic pulp blood-flow response to substance P in the dog as measured with a radiolabelled, microsphere injection method

Effect of Iontophoretical Application of NK1 Receptor Antagonists on Pulpal Blood Flow in Cats

The influence of NK1 receptor antagonists applied iontophoretically on pulpal blood flow (PBF) was investigated. Along with substance P (SP, 0.8 approximately 20.0 ng/kg) administration to the canine pulp through the catheterized lingual artery, two NK1 receptor antagonists, [D-Pro2,D-Trp7,9]-SP and [D-Pro2,D-Phe7,D-Trp9]-SP (0.2 approximately 3.4 mM) were applied iontophoretically (cathodal current, 0.02 approximately 0.1 mA, 1 min) to the prepared class V dentinal cavity of ipsilateral teeth in 11 generally anesthetized cats. A paired t-test showed that SP administration caused significant increases of PBF (p < 0.05) without changing systemic blood pressure, and that SP and SP antagonist administration caused significantly less increase of PBF than in control of SP and 0.9% saline administration (p < 0.05). These data provide evidence that the iontophoretic application of NK1 receptor antagonists effectively attenuates SP-induced vasodilatation and show the possibility of their use in the control of neurogenic inflammation in the dental pulp.

The effects of neuropeptides (calcitonin gene-related peptide and substance P) on cultured human pulp cells

The sensory neuropeptides substance P and calcitonin gene-related peptide have been implicated in the mediation of pulpal inflammation. A possible role in healing following injury has also been suggested (Byers et al., 1990). This possibility has been investigated by an examination of a direct effect of substance P and calcitonin gene-related peptide in vitro on fibroblast-like cells derived from human dental pulp. Cells were cultured for 48 hr in Dulbecco's modified Eagle medium plus 20% fetal calf serum and antibiotics. Substance P and calcitonin gene-related peptide were added in the range from 10(-12) to 10(-4) mol/L. Fibroblast growth factor was used as a positive control. Effects on cell proliferation were assessed by cell counts (daily for 6 days) and [3H]-thymidine uptake (24 hr after the addition of peptides). An effect on cellular functional activity was measured by [35S]-sulfate incorporation into glycosaminoglycans, in confluent cell cultures. Both substance P and calcitonin gene-related peptide showed concentration-dependent stimulation of cell proliferation. The maximum stimulation of approximately 40% was achieved at substance P and calcitonin gene-related peptide concentrations of 10(-6) mol/L, comparable with stimulation by fibroblast growth factor. By contrast, little increase in glycosaminoglycan synthesis by confluent cells could be detected. The direct effect on pulp cells is consistent with a role of the neuropeptides in pulp healing. This is exerted at the level of cell proliferation, rather than functional activity.

Teeth and tooth nerves

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

Optical characteristics of human extracted teeth and the possible application of photoplethysmography to the human pulp

In order to record pulp blood flow by photoplethysmography, the light transmission properties of extracted human teeth and human peripheral blood at wavelengths between 400 and 800 nm were first investigated. Transmission through peripheral blood and extracted teeth was lower at wavelengths shorter than 600 nm. Transmitted-light photoplethysmography (TLP) was applied to teeth in situ using a tungsten light, or one of two light-emitting diodes (LED) with peak wavelengths of 565 and 695 nm. A CdS-CdSe photoconductive cell was used as a detector. The LED with a peak intensity at 565 nm was the most efficient of the three light sources for recording the TLP. The results indicate that the TLP could be used to assess pulp vitality.

Effects of systemic and topical nicotine on pulpal blood flow in dogs

It has been suggested that nicotine exerts cardiovascular effects which are similar to stimulation of the sympathoadrenal system. If this observation is true, nicotine administration would decrease pulpal blood flow and possible alter the pulpal response to injury. The purpose of this study was to measure pulpal blood flow in dogs using the radiolabelled microsphere method following topical or systemic administration of nicotine for 28 days. Thirteen dogs were divided into three groups. Group one received topical nicotine (8 mg nicotine/kg/day) combined with orabase which was applied in two equal doses to the mandibular anterior gingiva. Group two received systemic nicotine (2.5 mg/kg/day) delivered by osmotic pumps implanted subcutaneously in the back of each animals' neck. Group three were controls, and these animals received either topical orabase twice daily applied to the mandibular anterior gingiva or saline via osmotic pumps. Results indicated pulpal blood flow increased from Day 0 to Day 28 in both nicotine treated groups. Group one (topical nicotine) exhibited a mean increase in blood flow of 21.8 ml/min/100 g, while group two exhibited a mean increase of 50.1 ml/min/100 g. Group three, the control animals, exhibited a mean decrease in pulpal blood flow of 22.1 ml/min/100 g over the 28-day interval. These changes were not statistically significant (p > 0.05).

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

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

An in vitro method to evaluate regulation of neuropeptide release from dental pulp

Although pulpal neuropeptides such as calcitonin gene-related peptide and substance P may mediate neurogenic inflammation, little is known about the regulation of neuropeptide release from dental pulp. This article describes an in vitro method for superfusing dental pulp which permits the study of mechanisms regulating the release of immunoreactive CGRP (iCGRP). Tissue extracts from bovine dental pulp dilute in parallel to authentic calcitonin gene-related peptide and substance P peptide standards when assayed by radioimmunoassay. Pulpal levels of iCGRP were 17-fold greater than levels of immunoreactive substance P. Administration of a potassium pulse evoked a significant release of iCGRP from dental pulp (155 +/- 21 fmol/g/9 min) as compared with iCGRP spontaneously released from concurrent control chambers (18 +/- 11 fmol/g/9 min). The in vitro superfusion of pulp tissue may serve as a useful method for identifying peripherally acting drugs which modulate nociceptor secretory activity and for determining their mechanisms of action.

Effect of injury on pulpal levels of immunoreactive substance P and immunoreactive calcitonin gene-related peptide

Neuropeptides such as calcitonin gene-related peptide (CGRP) and substance P are present in dental pulp in relatively high concentrations. Previous studies have demonstrated that the staining density of immunoreactive CGRP (iCGRP) changes in dental pulp after tissue injury. This study evaluated injury-related changes in levels of both immunoreactive CGRP (iCGRP) and immunoreactive substance P (iSP) in dental pulp using radioimmunoassays. After pulpal exposure, iSP levels decreased to about 10% of baseline values, while iCGRP levels decreased to about 45% of baseline measures. After dentin exposure with acid etch, iSP levels decreased to about 10 to 20% of baseline measures, while iCGRP levels decreased to 60% of baseline values. For both forms of injury, iSP decreased to a greater extent than did iCGRP levels. Collectively, these findings indicate that pulpal neuropeptides undergo dynamic, injury-specific, and peptide-specific responses following trauma to dental pulp.

Dual wavelength spectrophotometry as a diagnostic test of the pulp chamber contents

The purpose of this in vitro study was to determine the feasibility of using dual wavelength spectrophotometry to identify teeth with pulp chambers that are either empty, filled with fixed pulp tissue, or filled with oxygenated blood. In phase I of the experiment, a human third molar was prepared so that its pulp space could be filled with oxygenated blood and later emptied. In phase II, the lower jaw of a beagle dog was removed and placed in formalin, thereby fixing the pulps of the teeth. The pulp of the right canine was removed via an apical approach, and attachments were placed in a similar position to those on the human tooth, to allow filling and emptying of the pulp space. Cavit was placed over the exposed fixed pulp in the left canine. Ten readings, which were separated by light source and detector removal and replacement, were taken of the right canine pulp space when it was empty or filled with oxygenated blood, or the left canine pulp space when it was filled with fixed tissue. Distinct and reproducible changes were measured for pulp spaces filled with air, tissue, or oxygenated blood. In phase III, simulated pulp testing on a dog tooth model was performed. Blood was introduced into the root canal space, the chamber was rinsed with water and replaced with air, according to a predetermined code. Spectrophotometer readings were recorded. The identification of pulpal contents was correctly determined in all 20 of the predetermined conditions. The findings indicate that continuous wave spectrophotometry may become a useful pulp testing method.

Biologic properties of eugenol and zinc oxide-eugenol. A clinically oriented review

Eugenol-containing dental materials are frequently used in clinical dentistry. When zinc oxide-eugenol (ZOE) is applied to a dentinal cavity, small quantities of eugenol diffuse through the dentin to the pulp. Low concentrations of eugenol exert anti-inflammatory and local anesthetic effects on the dental pulp. Thus use of ZOE temporary filling may facilitate pulpal healing; on the other hand, high eugenol concentrations are cytotoxic. Direct application of eugenol to pulp tissue may result in extensive tissue damage. The ability of ZOE-based endodontic sealers to influence periapical tissue healing is considered in view of eugenol's anti-inflammatory and toxic properties.

Response of pulpal blood flow to intra-arterial infusion of endothelin

Laser Doppler flowmetry was used to determine the effect of the vasoconstrictor endothelin 1 (ET-1) on the pulpal blood flow of intact dogs' teeth during mandibular arterial infusion. ET-1 produced a profound decrease in pulpal blood flow of a relatively long duration at lower doses than similar infusions of norepinephrine. The decrease in pulpal blood flow in response to ET-1 was partially attenuated by the calcium channel blocker nifedipine. These findings demonstrate the presence of receptors for ET-1 in the microvasculature of the dental pulp and suggests that ET-1 may function in the local control of the pulpal microcirculation.

Neurovascular interactions in the dental pulp in health and inflammation

The two key components in pulpal inflammation are microcirculation and sensory nerve activity. With advancement of techniques they can be measured simultaneously in the same tooth. Excitation of A-delta fibers seems to have an insignificant effect on pulpal blood flow (PBF), whereas C fiber activation causes an increase in PBF. This C fiber-induced PBF increase is caused by neurokinins, especially substance P, which is released from the C fiber nerve terminals. Manipulation of PBF has varying effects on sensory nerve activity. An increase in PBF causes excitation of both A-delta and C fibers via an increase in tissue pressure, whereas flow reduction has an inhibitory effect on A-delta fibers, but no discernible effect on C fiber activity. Understanding of this complex neurovascular relationship in the pulp, especially given the fact that the pulp is in a low compliance system, is prerequisite to more comprehensive characterization of pulpal inflammation.

Comparison of the effects of intra-arterial and locally applied vasoactive agents on pulpal blood flow in dog canine teeth determined by laser Doppler velocimetry

The vasoactive agents norepinephrine, 5-hydroxytryptamine, isoproterenol and bradykinin, at concentrations which changed local arterial pressure without changing systemic arterial pressure significantly, were injected intra-arterially (i.a.) into the maxillary artery or applied directly in a deep dentinal cavity on the buccal surface of canine teeth. The probe of a laser Doppler velocimeter was placed in the cavity to monitor pulpal blood flow. Bolus i.a. injections of the vasoconstrictors norepinephrine and 5-hydroxytryptamine produced a statistically significant (p less than 0.05) reduction in pulpal blood flow, 21.1 +/- 3.7 and 30.7 +/- 15.2%, and the local arterial pressure from the lateral nasal artery increased with norepinephrine but decreased with 5-hydroxytryptamine. The i.a. injections of the vasodilators isoproterenol and bradykinin were found to decrease both local arterial pressure and pulpal blood flow, 17.7 +/- 6.0 and 22.7 +/- 4.2%, respectively (p less than 0.05). However, local application of isoproterenol and bradykinin caused a biphasic response: an increase in pulpal blood flow, 8.6 +/- 1.6 and 9.4 +/- 1.1% (p less than 0.05), followed by a decrease, 19.1 +/- 11.9 and 5.3 +/- 2.1% (p greater than 0.005). Local application of norepinephrine and 5-hydroxytryptamine caused a decrease in pulpal blood flow, 23.7 +/- 5.2% (p less than 0.05) and 9.3 +/- 5.2% (p less than 0.05), respectively. These findings were in accordance with those from other reliable methods, such as injections of radioisotope-labelled 15 microns microspheres and the 133Xe washout technique, making laser Doppler flowmetry a reliable alternative. In addition, the biphasic response to the locally applied vasodilators and the reduction of pulpal blood flow after i.a. injection of vasodilators suggest that regulation of pulpal blood flow is determined by the combined effects of the low compliance environment and the stealing of perfusion to the pulp by the neighbouring tissues.

Hemodynamic regulation of the dental pulp in a low compliance environment

Pulpal hemodynamic regulation has been investigated in experimental animals using 133Xe washout, 15-microns radioisotope-labeled microsphere injection, and intravital microscope methods. Three distinct types of pulp blood flow reductions were observed. Type I was characterized by reduction in response to direct stimulation of the sympathetic nerve; intraarterial infusion of norepinephrine, 5-HT, or prostaglandin F2 alpha; and indirect stimulation of the sympathetic nerve. The Type II response, an initial increase in flow followed by a decrease, was observed with isoproterenol, prostaglandin E2, substance P, and bradykinin. This biphasic flow response is caused by the low compliance environment of the tooth and may play a role in pulp inflammatory processes. The Type III response follows administration of histamine and is characterized by a gradual decrease in pulpal blood flow.

Quantitative assessment of microcirculation in the rat dental pulp in response to alpha- and beta-adrenergic agonists

Responses to intra-arterial injections of the alpha-agonist, norepinephrine, the beta-agonist, isoproterenol, and to selected blockers were investigated in vivo by intravital microscopy. Luminal diameters (D) of pulpal microvessels and red cell velocities (Vrbc) were measured simultaneously to facilitate calculation of volumetric blood flow (Q). Norepinephrine caused a decrease in D, mean red cell velocity (Vm) and Q within individual microvessels. These responses were blocked by the alpha-antagonist, phenoxybenzamine. In response to the arteriolar D increase and venular D and Q decrease with isoproterenol, a transient increase in arteriolar Q was followed by a decrease within the first 60 s. No such effects were observed when the beta-antagonist, propranolol, was administered before the isoproterenol injection. The biphasic response in Q in response to isoproterenol is most likely related to the low compliance of the pulp. In the low-compliance environment a passive compression of venules could result from an active dilation of arterioles with an attendant rise in extravascular tissue pressure.