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

Evaluation of the Effect of Antihypertensive Drugs on the Values of Dental Pulp Oxygen Saturation in Hypertension Patients: A Case-Control Study

Purpose This study aimed to know about the positive or negative effect of antihypertensive drugs of different groups on the values of dental pulp oxygen saturation in hypertension patients. Materials and Methods A case-control study to evaluate the impact of the antihypertensive drugs on the values of dental pulp oxygen saturation in hypertension patients. The studied sample consisted of 40 participants, and they were distributed into two groups: Group I (n=20): Hypertension patients treated with antihypertensive drugs, and Group II (n=20): Healthy participants. A finger pulse oximeter was recorded after a rest period of 15 minutes by BCI® Advisor® vital signs monitor. The patient was then asked to use a chlorhexidine digluconate mouth rinse for five minutes, and the two dental pulp pulse oximeters for the central upper incisors were also recorded for all participants. Data were analyzed using the Mann-Whitney U test. Results ​​​​​​The results showed that there was no significant difference between the finger pulse oximeters of the two studied groups (P-value = 0.421). The two dental pulp oxygen saturation was higher than the control group with statistically significant (P-value = 0.043, P-value = 0.002). Conclusions Within the limitation of this study, it can be concluded that antihypertensive drugs increase the dental pulp oxygen saturation in patients with hypertension who are treated with antihypertensive drugs, and thus there is a positive effect of these drugs in stimulating the dental pulp.

Sympathetic Regulation of Tertiary Dentinogenesis via Beta-2 Adrenergic Receptor on Rat Odontoblasts

INTRODUCTION

Beta-2 adrenergic receptor has been found within the osteoblast membrane meditating bone remodeling. Propranolol is a sympatholytic beta antagonist commonly used as long-term medication for the management of many common diseases such as hypertension. This study was performed to verify the presence of this receptor on odontoblasts in rats and, if present, to investigate its possible association with tertiary dentinogenesis.

METHODS

Twenty male Sprague-Dawley rats (9 weeks old) were randomly assigned to 4 groups: CP0.8 group, cavity preparation + propranolol treatment (0.8 mg/day, n = 5); CP4 group, cavity preparation + propranolol treatment (4.0 mg/day, n = 7); CON group, cavity preparation + saline treatment (0.2 mL/day, n = 5); and NT group, no treatment (n = 3). Cavity preparation was performed on the mesial aspect of the maxillary first molars bilaterally. After 2 weeks, the tertiary dentinogenesis (CP0.8, CP4, and CON) was examined by hematoxylin-eosin staining, and the localization of beta-2 adrenergic receptor (NT) was examined by immunohistochemistry.

RESULTS

The beta-2 adrenergic receptor immunoreactivity was observed in the odontoblastic layer in normal rat molar dental pulp. The tertiary dentinogenesis beneath the prepared cavity was significantly higher in the rats receiving 2-week systemic administration of propranolol than in those without the propranolol treatment. The higher-dose treatment of propranolol (P < .001) presented more effective up-regulation of tertiary dentinogenesis than the lower-dose treatment (P < .01).

CONCLUSIONS

These results indicate that the sympathetic nervous system decreases tertiary dentin formation via beta-2 adrenergic receptors located on rat odontoblasts. It suggests that adrenergic beta antagonist is expected to use in the treatment of inducing tertiary dentin formation to protect dental pulp.

Differential cholinoceptor modulation of nitric oxide isoforms in experimentally-induced inflammation of dental pulp tissue

AIM

The aim of the study was to investigate the role of muscarinic acetylcholine receptor (mAChR) activity in the regulation of endothelial (e), neuronal (n) and inducible (i) nitric oxide synthase (NOS) activity and expression in experimentally induced inflammation of rat dental pulp tissue.

METHODOLOGY

Inflammation was induced by application of bacterial lipopolysaccharide (LPS) to the pulp. Extirpated pulp-tissue samples were incubated in saline solution until the various experiments were performed. Saline-treated pulp and healthy pulp tissues were used as controls. NOS activity was measured by the production of [U-(14)C]-citrulline from [U-(14)C]-arginine. Nitrite/nitrate assay was evaluated by the conversion of nitrate to nitrite in the presence of nicotinamide adenine dinucleotide phosphate. i-nos, e-nos and n-nos mRNA levels were measured using reverse-transcriptase polymerase chain reaction by co-amplification of target cDNA with a single set of primers.

RESULTS

Application of LPS to the pulp increased NOS activity and nitrate production (P < 0.001), generated by iNOS over-activity and expression. Pilocarpine acting on mAChRs triggered a biphasic action on NOS activity and NO accumulation. At low concentrations, pilocarpine induced a negative effect associated with a decrease in i-nos mRNA level, whilst at high concentration, it produced a positive effect associated with increased e-nos and n-nos mRNA levels. In control pulp tissue, only the positive effect of pilocarpine was observed.

CONCLUSIONS

Irreversible pulpitis changes mAChR conformation increasing its efficiency of coupling to transducing molecules that in turn induce activate iNOS. The capacity of pilocarpine to prevent NO accumulation and iNOS activity, by acting on mAChR mutation induced by pulpitis, might be useful therapeutically as a local treatment.

Differential signalling pathways involved in cholinoceptor-dependent stimulation of nitric oxide isoforms in dental pulp

AIM

To investigate the role of muscarinic acetylcholine receptor (mAChR) subtype activity in the regulation of endothelial- (e) and neuronal- (n) nitric oxide synthase (NOS) expression and activity.

METHODOLOGY

Rat dental pulp tissue was used throughout the study. The e-nos and n-nos mRNA levels were specifically measured using reverse transcriptase polymerase chain reaction procedures that involve simultaneous co-amplification of both target cDNA and a reference template with a single set of primers. NOS activity was measured by the production of [U-(14)C]-citrulline from [U-(14)C]-arginine.

RESULTS

Stimulation of M(1)/M(2) and M(3)/M(4) mAChRs with pilocarpine caused an increase in e-nos and n-nos mRNA levels and NOS activity in the dental pulp. The specific mAChR subtype antagonists, L-NMMA, l-NIO and N(2)-propyl-L-arginine but not aminoguanidine attenuated all these effects. Inhibitors of phospholipase C (PLC), protein kinase C (PKC) and calcium/calmodulin (CaM) prevented the pilocarpine-dependent increase in n-nos and e-nos mRNA levels and NOS activity.

CONCLUSIONS

Activation of mAChR subtypes stimulated NOS activity by increasing the production of NO through e-nos and n-nos gene expression and NOS activity. The mechanism appears to occur secondarily to stimulation of CaM and PKC enzymatic activity.

Effects of local injections of vasoactive drugs on eruption rate of incisor teeth in anaesthetized rats

OBJECTIVES

Previous studies have suggested that the vasculature in the dental pulp and periodontal tissues plays an important role in producing the eruptive force in continuously erupting incisors. The aim of the present study was to investigate the effects of local injections of vasoactive drugs on regional blood flow within the socket in association with axial tooth movements to clarify the role of the local vascular system on tooth eruption.

DESIGN

Twenty-two male Wistar rats, weighing 309+/-21 g (S.D.), were immobilized with halothane anaesthesia. We measured the regional blood flow within the socket using a laser Doppler flowmeter, and the axial movements of the mandibular incisor using a displacement detector. The local injections of the vasoactive drugs, adrenaline (0.001, 0.01, and 0.1 microg/kg body weight) and acetylcholine (0.05, 0.5, and 5 microg/kg), into the base of the incisor were performed by a microinjector at a rate of 1 microl/kg body weight.

RESULTS

The injections of various doses of adrenaline decreased the mean regional blood flow and eruption rate dose-dependently, while those of acetylcholine increased the mean regional blood flow and eruption rate dose-dependently. The changes in the regional blood flow and eruption rate were transient. Significant correlations (p<0.001) were obtained between the maximum and minimum values in the regional blood flow and in the eruption rate following injections of various doses of adrenaline and acetylcholine.

CONCLUSION

These results support the hypothesis that the eruptive force of the rat incisor is closely related to the vasculature within the socket.

Relationship between the tooth eruption and regional blood flow in angiotensin II-induced hypertensive rats

OBJECTIVE

The mechanism of action of vasoactive drugs on tooth movement is unknown. The purpose of the present study was to measure simultaneously the axial movement of the mandibular incisor, regional blood flow at the base of the incisor, and systemic arterial blood pressure in angiotensin II-induced hypertensive rats to determine the possible cause of tooth displacement.

DESIGN

The measurements were made under artificial respiration with halothane anaesthesia. In the experimental animals, 2.5 microg of angiotensin II in 1 ml of Ringer's solution was infused at 0.83 ml/h for 12 h from the femoral vein. In the control animals, only Ringer's solution was infused.

RESULTS

Angiotensin II caused an increase of the mean arterial blood pressure from 86 to 119 mm Hg, and decreases of the eruption rate from 667 to 494 microm/24 h and the regional blood flow from 262 to 214 mV. There was a positive correlation between the eruption rate and regional blood flow, and a negative correlation between the blood pressure and regional blood flow.

CONCLUSION

These results suggest that angiotensin II caused constriction of the peripheral vascular smooth muscle resulting in an increase of arterial blood pressure and a decrease of regional blood flow, followed by a decrease of fluid volume and then a reduction of either the pressure within the socket or of the eruptive force. We assume that the regional vascular pressure within the socket plays an important role in determining the position of the rat incisor.

Pharmacological properties of serotonin receptor subtypes mediating contraction of bovine inferior alveolar arteries

OBJECTIVE

To characterise the 5-hydroxytryptamine (5-HT) receptor subtypes mediating contraction of the inferior alveolar artery. Additionally, to determine the role of cyclooxygenase products, nitric oxide, endothelium, monoamine oxidase and 5-HT uptake in modulating contraction of inferior alveolar arteries to 5-HT.

METHODS

Contractile responses to 5-HT were examined in vitro using ring segments of bovine inferior alveolar arteries. Affinity constants (K(B)'s) of subtype-selective 5-HT receptor antagonists were determined to characterise the 5-HT receptor-subtypes causing contraction of inferior alveolar arteries.

RESULTS

In 100 nM ketanserin or 30 nM spiperone, 5-HT caused a biphasic contraction best-fit by a two-site curve model, where one site was antagonist-sensitive and the other site antagonist-insensitive. 5-HT(2A) receptor-subtype selective antagonists, ketanserin and spiperone, blocked 5-HT induced contraction with K(B)'s of 1.0 and 0.16 nM, respectively. RS102221 (5-HT(2C) selective) and (S)-WAY100135 (5-HT(1A) selective) blocked 5-HT stimulated contraction with low affinities (K(B)'s=100 nM and 330 nM, respectively). GR55562, a 5-HT(1) receptor subtype antagonist with a reported affinity of 500 nM at the 5-HT(1D) receptor subtype, blocked 5-HT induced contraction with a K(B) of 470 nM. Cylooxygenase inhibition with 50 microM ibuprofen caused a 44% increase in maximal contraction to 5-HT; whereas, nitric oxide inhibition with N(G)-nitro-L-arginine, endothelium removal or inhibition of 5-HT uptake and monoamine oxidase with imipramine and iproniazid, respectively, did not affect 5-HT contraction.

CONCLUSIONS

Both 5-HT(2A) and 5-HT(1D/1B) receptor subtypes mediate 5-HT induced contraction of the bovine inferior alveolar artery. 5-HT stimulated contraction of the inferior alveolar artery is modulated by a vasodilator prostaglandin.

beta 2-Adrenoceptor regulation of CGRP release from capsaicin-sensitive neurons

Previous studies have suggested that neurotransmitter substances from the sympatho-adrenomedullary system regulate pulpal blood flow (PBF), in part, by the inhibition of vasoactive neuropeptide release from pulpal sensory neurons. However, no study has evaluated the role of beta-adrenoceptors. We evaluated the hypothesis that activation of beta-adrenoceptors inhibits immunoreactive calcitonin gene-related peptide (iCGRP) release from capsaicin-sensitive nociceptive neurons via in vitro superfusion of bovine dental pulp. Either norepinephrine or epinephrine inhibited capsaicin-evoked iCGRP. The norepinephrine effect was blocked by the selective beta(2)-adrenoceptor antagonist, ICI 118,551, but not by pre-treatment with the selective beta(1)-adrenoceptor antagonist, atenolol. In addition, application of albuterol, a selective beta(2)-adrenoceptor agonist, significantly blocked capsaicin-evoked release of iCGRP. Collectively, these studies demonstrate that activation of beta(2)-adrenoceptors in dental pulp significantly reduces exocytosis of neuropeptides from capsaicin-sensitive nociceptors. This effect may have physiologic significance in regulating PBF. Moreover, since capsaicin selectively activates nociceptors, beta(2)-adrenoceptor agonists may have clinical utility as peripherally acting therapeutics for dental pain and inflammation.

An in vivo and in vitro comparison of the effects of vasoactive mediators on pulpal blood vessels in rat incisors

The effects of endogenous vasoactive substances were evaluated in anaesthetized rats using a laser Doppler flowmeter to monitor changes in pulpal blood flow, as well as directly in isolated pulpal arteriole preparations utilising a microperfusion and monitoring system to observe changes in vessel diameter. In anaesthetized rats, while systemic arterial blood pressure remained relatively stable, intra-arterial delivery of adrenaline (epinephrine) (A), noradrenaline (norepinephrine) (NA), phenylephrine (PHE), dopamine (DOPA), 5-hydroxytryptamine (5-HT), or endothelin-1 (ET-1) produced a dose-dependent reduction in pulpal blood flow (order of potency: ET-1>>A=NA>PHE=DOPA=5-HT); acetylcholine induced a dose-dependent increase in pulpal blood flow; histamine, isoproterenol and adenosine produced no significant changes. In isolated arteriole preparations, intraluminal delivery of A, NA, PHE, DOPA or 5-HT produced dose-dependent vasoconstriction (A=NA>PHE=DOPA=5-HT). Acetylcholine relaxed NA-precontracted vessels dose-dependently. Histamine and isoproterenol produced a small vasodilatation. Intraluminal ET-1 produced a small vasoconstriction at 10(-8)M, whereas extraluminal ET-1 produced a dose-dependent vasoconstriction from 10(-10)M and above. Intraluminal adenosine failed to dilate vessels precontracted with ET-1, whereas extraluminal adenosine caused a complete relaxation. These combined in vivo and in vitro data suggest that, in the rat incisor, the pulpal microcirculation is capable of functional regulation and that pulpal blood flow may be modulated by endothelium-related factors, metabolic (tissue-related) factors, as well as humoral (blood-borne) factors.

Immunolocalization of semicarbazide-sensitive amine oxidase in human dental pulp and its activity towards serotonin

The semicarbazide-sensitive amine oxidase (EC 1.4.3.6; SSAO) from crude homogenates of human dental pulp was shown to catalyse the oxidative deamination of 5-hydroxytryptamine (serotonin; 5-HT) with a K(m) of 318+/-52 microM. In this respect the human enzyme resembles that in pig dental pulp, but differs from SSAO in all other tissues studied, which are inactive towards 5-HT. A method is described for obtaining intact dental pulp in which the anatomical details are preserved. Extracted teeth are frozen in dry ice and later defrosted rapidly before being fractured in a mechanical vice, facilitating pulp removal. Immunohistochemistry showed SSAO in the odontoblast layer, nerve fibres and blood vessels. The presence of SSAO in nerves in dental pulp appears to be unique. Tryptophan hydroxylase, a key enzyme in 5-HT synthesis, was also demonstrated in nerves and the odontoblast layer of human dental pulp.

Agonist-induced vasoactive responses in isolated perfused porcine dental pulpal arterioles

A novel isolated perfused pulpal arteriole preparation and microperfusion system was used to evaluate the direct vasoactive responses of pulpal arterioles to selected agonists. Short lengths of porcine pulpal arterioles (101.7+/-2.2 microm o.d., n=105) were dissected out and placed in an environment-controlled bath on the stage of an inverted microscope. Both ends of the vessel were cannulated and perfused at a controlled rate through the lumen. The diameter of the vessel was measured online. Following equilibration, the vessel was challenged with various agonists: adrenaline (epinephrine), noradrenaline (norepinephrine), phenylephrine, dopamine, isoproterenol, 5-hydroxytryptamine, histamine and adenosine. The endothelium-dependent vasodilator acetylcholine was used to evaluate endothelial cell function. Adrenaline, noradrenaline, phenylephrine, 5-hydroxytryptamine and dopamine caused dose-dependent contractions (adrenaline=noradrenaline>phenylephrine>dopamine>5-hydroxytryptamine). Isoproterenol and histamine provoked a dose-dependent dilation. Adenosine produced pronounced vasodilatation in vessels precontracted with 10(-8)M endothelin-1. Functional adrenergic, histamine, 5-hydroxytryptamine and adenosine receptors are, therefore, present in porcine pulpal arterioles. The isolated perfused pulpal arteriole preparation may prove valuable in understanding local control mechanisms of pulpal microcirculation.

Blood flow changes in human dental pulps when capsaicin is applied to the adjacent gingival mucosa

OBJECTIVE

The purpose of this study was to determine whether changes occur in pulpal blood flow when capsaicin is applied to the adjacent gingival or alveolar mucosa in human beings.

STUDY DESIGN

Laser Doppler flowmetry was used to measure changes in pulpal blood flow (PBF) after applying capsaicin to adjacent gingival mucosa in 20 human volunteers. The procedure was repeated on 10 subjects after administration of an ipsilateral inferior alveolar nerve block and on the other 10 subjects after application of topical anesthetic to their adjacent gingival and alveolar mucosa.

RESULTS

PBF increased in 16 subjects and did not change in 4 subjects after capsaicin application. Ipsilateral inferior alveolar nerve block did not alter this effect. Pretreatment with topical lidocaine resulted in no change or decreased PBF in 8 subjects and increased PBF in 2 subjects.

CONCLUSION

Changes occur in the PBF of the mandibular canine teeth of some humans when capsaicin is applied to the adjacent gingival or alveolar mucosa.

Patterns of tooth wear associated with methamphetamine use

BACKGROUND

Methamphetamine (MAP) abuse is a significant worldwide problem. This prospective study was conducted to determine if MAP users had distinct patterns of tooth wear.

METHODS

Methamphetamine users were identified and interviewed about their duration and preferred route of MAP use. Study participants were interviewed in the emergency department of a large urban university hospital serving a geographic area with a high rate of illicit MAP production and consumption. Tooth wear was documented for each study participant and scored using a previously validated index and demographic information was obtained using a questionnaire.

RESULTS

Forty-three MAP patients were interviewed. Preferred route of administration was injection (37%) followed by snorting (33%). Patients who preferentially snorted MAP had significantly higher tooth wear in the anterior maxillary teeth than patients who injected, smoked, or ingested MAP (P = 0.005).

CONCLUSION

Patients who use MAP have distinct patterns of wear based on route of administration. This difference may be explained anatomically.

Dose-response effects of adrenergic drugs on axial movements of the rat mandibular incisor and on arterial blood pressure

Axial tooth movements and arterial blood pressure were measured following the intravenous injection of 0, 0.01, 0.1, 1, or 10 micrograms/kg of adrenaline, noradrenaline or isoprenaline. Adrenaline caused a dose-dependent, rapid, extrusive tooth movement with a nearly simultaneous increase in blood pressure, followed by a marked intrusive tooth movement and a decrease in blood pressure. Noradrenaline caused a dose-dependent, rapid, extrusive tooth movement and an increase in blood pressure, but a subsequent intrusive tooth movement and decrease in blood pressure were not so marked. Isoprenaline caused a marked intrusive tooth movement and a decrease in blood pressure, without an extrusive tooth movement and increase in blood pressure. The time required to reach the maximum intrusive tooth movement was delayed after that to reach the maximum decrease in blood pressure. The recovery time of the intrusive tooth movement was much more delayed than that of blood pressure. These results suggest that the extrusive movement of the rat incisor was primarily related to the rise of arterial blood pressure due to stimulation of vascular alpha-receptors. It is also suggested that stimulation of beta-receptors would probably cause vasodilatation of arteries that would make the pressure in the small vessels in the microcirculation of the socket fall, so reducing the volume of blood and interstitial fluid in the socket followed by a marked and continuing intrusive tooth movement.

Antagonistic effect of D-myo-inositol-1,2,6-trisphosphate (PP56) on neuropeptide Y-induced vasoconstriction in the feline dental pulp

Intra-arterial injection of neuropeptide Y (NPY) (1.3-2.0 micrograms/kg) resulted in decreases of pulpal blood flow by 37.7 +/- 5.7% (mean +/- SEM). The intra-arterial injection of D-myo-inositol-1,2,6-trisphosphate (PP56) (0.3 mg/kg) alone changed pulpal blood flow by 1.0%. The effect of NPY in the presence of PP56 resulted in significantly smaller decreases in pulpal blood flow ranging from 27.2 +/- 5.4 to 16.6 +/- 3.5% from control as compared with NPY alone. In effect, PP56 partially blocked the decreases in pulpal blood flow caused by NPY. The electrical stimulation of the sympathetic nerve alone resulted in decreases in pulpal blood flow of 41.7 +/- 6.2%. The electrical stimulation of the sympathetic nerve following the intra-arterial administration of PP56 decreased pulpal blood flow by 23.1 +/- 6.0% from control, significantly less than the sympathetic nerve stimulation alone. PP56 attenuated the decrease in pulpal blood flow caused by the sympathetic nerve stimulation by 44.4 +/- 11.0%. Similarly, the combination of PP56 and phentolamine followed by electrical stimulation of the sympathetic nerve reduced the decrease in pulpal blood flow caused by the sympathetic nerve stimulation alone by 43.0 +/- 8.6%. These results provide evidence that the non-peptide PP56 is capable of antagonizing vasoconstriction caused by NPY in the feline dental pulp. In addition, they show functional evidence that NPY as well as noradrenaline are released from the sympathetic nerve endings during its stimulation and cause vasoconstriction.

5-Hydroxytryptamine immunoreactivity is detectable in sympathetic nerve fibres in rat oral tissues

The aim of this investigation was to examine if 5-hydroxytryptamine (5-HT) is detectable not only in mast cells but also in sympathetic nerve fibres in oral sites of the rat, including the periodontal ligament, pulp, palatal mucosa, and vestibular sulcus. Antibodies against 5-HT and tyrosine hydroxylase were used. Maxillae from rats were dissected free, fixed, decalcified, cut transversally, and processed for immunohistochemistry. Nerve fibres showing 5-HT-like immunoreactivity were regularly observed in the walls of the arteries and arterioles in the vestibular sulcus and the periodontal ligament. However, 5-HT-like immunoreactivity was not seen in the walls of the vessels of the palatal mucosa. Interestingly, 5-HT-like immunoreactivity coexisted with tyrosine hydroxylase-like immunoreactivity in the innervation of the periodontal ligament and the vestibular sulcus. Thus, the present study gives morphological correlate for the occurrence of effects of 5-HT derived not only from mast cells but also from sympathetic nerve fibres in oral tissues. The source of 5-HT in the nerve fibres as well as the functional implications of the observations remain to be determined.

Environmental effects on laser Doppler pulpal blood-flow measurements in man

The increasing number of experiments using laser Doppler flowmetry in man for pulpal blood-flow recordings leads to questioning of the experimental recording conditions. The present study focused on three points: the design of the laser probe holder, the isolation of the tooth, and the influence of the recording site. A rigid polyurethane splint used in addition to different isolation devices (cotton roll, metal shield, rubber dam) was compared with a silicone splint. The silicone resulted in significantly higher values (+341%) than the polyurethane splint. The combination of the polyurethane splint with isolation devices decreased, in all cases, the flux values. The polyurethane/rubber-dam combination was the most efficient in individualizing the pulpal blood flow (-69% decrease). Recordings on non-vital teeth confirmed the hypothesis that there was periodontal contamination of the recorded flow, as the signal was abolished when using the polyurethane/rubber-dam combination. Cervical recording sites gave significantly higher values than occlusal sites (+42%). It is concluded that, in man, the part played by the periodontium may have been underestimated in previous recordings of pulpal blood flow. The use of a rubber dam in combination with a rigid splint to enhance the validity of recordings is proposed.

Neural control of pulpal blood flow

Blood flow of mammalian dental pulp is under both remote and local control. There is evidence for the existence of parasympathetic nerves in the pulp, but functionally the cholinergic influence is weak, and the physiological significance of this autonomic system seems to be low. The evidence for sympathetic vasoconstrictor nerves in the pulp is robust, and there is convincing support for the contention that these nerves play a physiological role, operating via release of noradrenaline and neuropeptide Y. However, there is no significant functional evidence in support of sympathetic beta-adrenoceptor-mediated vasodilation in the pulp. The local control of blood flow involves a subset of intradental sensory nerves. By virtue of their neuropeptide content, these afferent fibers cause vasodilation and inhibit sympathetic vasoconstriction in response to painful stimulation of the tooth. Such locally governed control may serve to meet immediate demands of the pulp tissue. A locally triggered reflex activation of sympathetic nerves in the pulp may modulate this control and limit its magnitude. Thus, there are competitive interactions between local and remote vascular controls which may be put out of balance in the injured and inflamed dental pulp.

Haemodynamic and immunohistochemical studies of rat incisor pulp after denervation and subsequent re-innervation

The effects of injury to the inferior alveolar nerve on the distribution of neuropeptides and neurogenic blood-flow reactions were studied in rat mandibular dental pulp. In normal incisor pulps, calcitonin gene-related peptide (CGRP)-like immunoreactivity was common, while substance P- and neurokinin (NKA)-positive nerve fibres were much less abundant. There were no signs of vasoactive intestinal peptide-like, neuropeptide Y-like or 5-hydroxytryptamine-like immunoreactivity. In normal pulps, electrical stimulation (100 microA, 5 ms, 15 Hz for 30 s) of the tooth crown resulted in transient vasoconstriction followed by vasodilation, which was enhanced after alpha-adrenoceptor blockade. At 3 days-4 weeks after unilateral nerve section there were no signs of CGRP-, substance P- and NKA-immunoreactivity, and there was no vasodilation in response to tooth stimulation. The vasoconstrictor response was also absent during this period but at 4 weeks postoperatively a weak response was obtained and after 7 weeks the vasoconstrictor response had regained normal amplitude. At 7 weeks postoperatively, a large number of CGRP-positive fibres had reappeared and at 11 weeks the pattern of CGRP-immunoreactivity was normal. However, substance P- and NKA-immunoreactivity were not found at 7 or 11 weeks after surgery. Vasodilator responses appeared at 7 weeks, and showed normal amplitude at 11 weeks after the creation of the nerve lesion. The results show that during nerve regeneration, sympathetic vasoconstriction was regained earlier than neurogenic vasodilation in rat incisor teeth. The reappearance of neurogenic vasodilation after nerve injury was temporarily associated with the presence of CGRP-immunoreactivity in regenerating trigeminal afferent nerves.

Evidence for the role of nitric oxide in the circulation of the dental pulp

Many authors have studied the hemodynamics of the dental pulp; however, there are scarcely any data regarding the involvement of the L-arginine/nitric oxide pathway in the regulatory mechanism. Thus, we have examined the physiological effects of (1) NG-nitro-L-arginine as an inhibitor of nitric oxide synthesis and (2) the nitric oxide donor 3-morpholinosydnonimine on blood flow and vascular resistance in the canines of anesthetized cats to study the potential involvement of nitric oxide in the regulation of dental vascular homeostasis. Mean arterial blood pressure, heart rate, blood gases, pH, cardiac output, and tissue blood flow were determined prior to and 15 min after i.v. administration of either NG-nitro-L-arginine (30 mg/kg, n = 9) or 3-morpholinosydnonimine (1 mg/kg, n = 7). Blood flow was measured by radioactive-labeled microspheres. There were no significant differences in baseline parameters between the two groups of cats. The dental pulp blood flow decreased to 53 +/- 13% (p < 0.01) of the control level after NG-nitro-L-arginine administration, while it decreased only slightly (to 82 +/- 12%) after 3-morpholinosydnonimine administration. The dental pulp's vascular resistance increased to 367 +/- 69% (p < 0.01) of the control level after NG-nitro-L-arginine, while it decreased to 73 +/- 10% (p < 0.05) of control after 3-morpholinosydnonimine. We found that the L-arginine/nitric oxide pathway plays an important role in the regulation of pulpal blood circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Serotonin in rat oral tissues: role of 5-HT1 receptors in sympathetic vascular control

In this study we examined whether the indoleamine, serotonin (5-hydroxytryptamine, 5-HT), is contained in the rat incisor pulp and gingiva as well as its possible role in regulation of blood flow in these tissues. Tissue biochemical analysis, by means of high performance liquid chromatography coupled to electrochemical detection, revealed the presence of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA), as well as the catecholamine, dopamine, in both pulp and gingiva. Unilateral surgical sympathectomy or resection of the inferior alveolar nerve failed to affect 5-HT levels in either tissue while dopamine contents in the pulp and gingiva were diminished following sympathectomy. Electrical stimulation of the sympathetic trunk induced a frequency-dependent vasoconstriction in the pulp and gingiva as measured by laser Doppler flowmetry. This vasoconstriction was unaffected by infusion of 5-HT2 or 5-HT3 receptor antagonists or dopamine receptor antagonists but it was significantly reduced in both tissues after alpha 1-adrenoceptor blockade. During this blockade the remaining vasoconstriction induced by high frequency stimulation (16 Hz) was reduced in gingiva by the 5-HT1 receptor blocker, methiothepin. The results indicate an involvement of 5-HT1 receptors and alpha 1-adrenoceptors in the sympathetic vascular control in the gingiva.

Laser applications in dentistry: a review of the literature

While there are many applications of lasers in dentistry, few have advantages over existing technology. To date, lasers should be considered to be an adjunct to conventional techniques. There are also considerations of cost and rapid obsolescence of current laser equipment. The possible adverse effects of lasers on the tissues adjacent to those being irradiated, to users and to patients must also be considered.

Stimulation of intradentinal dye penetration by feeding in the rat

Dentinal fluid movement, as measured by intradentinal dye penetration (IDDP), may be under the control of an endocrine system that includes the parotid glands. It was earlier demonstrated that parotid hormone stimulates IDDP when infused into rats, and in the pig the onset of feeding signals the release into the circulation of immunoreactive parotid hormone (iPH), the titre of which remains elevated for more than 1 h after feeding. As, for technical reasons, it is impossible to measure iPH and IDDP activity in the same animal, the hypothesis that feeding causes IDDP stimulation in the rat was now tested. Feeding rats for 15 min stimulated IDDP to a level significantly higher than when fasting (0.418 +/- 0.040 versus 0.106 +/- 0.022, p < 0.001). Within the experimental conditions, IDDP stimulation lasted longer than 15 min. Sialoadenectomy before the feeding experiment did not change the feeding-stimulated IDDP response unless the parotid glands were removed. In parotidectomized and totally sialoadenectomized rats fed for 15 min, the level of IDDP was not different from that of sham-operated fasting animals. It is postulated that, in addition to the existence of possible local regulatory factors in the pulp, dentinal permeation may be under a physiological control mechanism involving a parotid endocrine function. It is also suggested that a hormonally controlled mechanism of dentinal fluid movement may play a systemic, protective role against the bacterial acidogenic challenge to teeth.

A study of cholinergic and beta-adrenergic components in the regulation of blood flow in the tooth pulp and gingiva in man

In 10 subjects, laser Doppler flowmetry was used to study whether cholinergic or beta-adrenergic pathways are involved in the control of tooth pulp blood flow (PBF) in response to isometric hand grip and the cold pressor test. We also examined if differences exist between the regulation of blood flow in the tooth pulp and the nearby gingiva (GBF). Isometric hand grip (35% of maximum force, 2 min) and the subsequent ischaemia (2 min) induced a brief rise in PBF and a more long-lasting rise in GBF. Atropine increased heart rate about by 40% and changed the pulpal response to a fall in flow, without altering gingival flow. Propranolol, causing a 20% reduction in heart rate, had no effect on either flow during the actual test, but induced a rise in GBF after the ischaemic period. The cold pressor test (2 min at 0.5 degrees C) resulted in a reduction in PBF and GBF, unaffected by the blocking drugs. With atropine, however, PBF increased immediately after this test. The relative changes in arterial pressure and heart rate were unaffected by the drugs. Our study has demonstrated the existence of cholinergic nervous vasodilation in vessels serving the tooth pulp. Non-adrenergic non-cholinergic mechanisms probably contribute to the evoked rise in GBF during exercise. Beta-adrenoceptors are involved in the control of GBF immediately after isometric exercise. While the two tests under control conditions evoked mostly parallel changes in PBF and GBF, the use of blocking agents showed that blood flow is controlled by different mechanisms in the two adjacent vascular beds.

Experiments on extracted teeth into the validity of using laser Doppler techniques for recording pulpal blood flow

The performances of two laser Doppler flow meters (Periflux model PF3 and Moor Blood Flow Monitor model MBF3D) were investigated. Recordings were made while diluted blood was pumped at different rates through the pulp cavities of extracted human or pig teeth. The probe of each instrument was fixed to the enamel surface 2 mm from the original position of the gingival margin. Both instruments performed similarly, although the Moor gave the better signal/noise ratios. Both were capable of detecting flow in the core of the pulp as well as the superficial part closest to the probe tip. With either instrument, and with any one dilution of blood (range 0.5-45% v/v red cells), there was a near-linear relationship between the blood-flow signal and the flow rate of blood through the tooth. However, when data obtained with different red-cell concentrations were compared, a good correlation between the blood-flow signal and red-cell flux (product of concentration and mean velocity) was obtained only with red-cell concentrations up to 1% v/v. Therefore these instruments would give an accurate indication of blood flow changes only under conditions in which either this value was not exceeded or if the red-cell volume fraction remained constant; neither of which can be assumed to apply when recording from teeth in situ. The signals representing the concentration of moving blood cells were unreliable in both instruments. It is concluded that the information provided by these laser Doppler flow meters can be ambiguous and must be interpreted with care.

Effects of autonomic reflexes on tooth pulp blood flow in man

In 15 subjects, laser-Doppler flowmetry (LDF) was used to investigate whether the nervous control of pulpal blood flow (PBF) is affected by three tests known to excite the sympathetic nervous system. For comparison, skin blood flow was similarly recorded. Dynamic exercise (bicycle ergometer, 5 min, 90-100 W) in eight subjects was accompanied by a rise in PBF. PBF was increased by the cold pressor test (2 min) in eight subjects, while in five the flow decreased or remained unaffected. The isometric hand grip (2 min, 30% MVC) and the subsequent muscle ischaemia (2 min) led to a rise in PBF in two subjects and a fall in four. Following unilateral anesthesia of the mandibular nerve, PBF in five subjects became unresponsive to dynamic exercise or the cold pressor test, indicating pressure autoregulation. All three tests triggered increases in mean arterial pressure (MAP) and heart rate (HR). Skin blood flow usually increased in response to the tests, but could also decrease, and often changed in a direction opposite to that of PBF. It is concluded that the circulation of blood in the human tooth is affected by evoked changes in autonomic nerve activity, involving activation of both vasodilator and vasoconstrictor nerves to vessels serving the tooth.

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.

Medication of the dental pulp: a review and proposals

For years, dentists have desired to treat the intact dental pulp. Since it is well-known that many substances, including some drugs, are capable of permeating dentin, we believe it is possible to treat certain types of pulpitis by applying drugs at the base of cavity preparations. Useful drugs include local anesthetics to block pain transmission, glucocorticoids or non-steroidal anti-inflammatory agents (NSAIA) to treat inflammation, NSAIA or narcotic analgesics for pain control, and antibiotics to treat infection. The literature is reviewed and proposals are presented to study medication of the dental pulp.

In situ testing of CO2 laser on dental pulp function: effects on microcirculation

The effect of CO2 laser irradiation on pulpal microcirculation was studied in cat canines. The enamel surfaces of 4 teeth were exposed with energy densities of 304-1440J/cm2, using either a handpiece or a microslad, with a focal spot of 0.21mm and 0.33mm respectively. Pulpal blood flow (PBF) before and following lasing was recorded through the intact tooth surface by a laser Doppler flowmeter. CO2 laser irradiation caused an increase in PBF, which was immediate and transient. The PBF increase was higher in a large pulp than in a small pulp, and it was inversely related to the focal spot size. These findings confirm that the dental pulp is thermally affected by CO2 lasing of the tooth surface, however, without extensive pulp coagulation. It is concluded that the effects of laser irradiation on the pulpal microcirculation may be studied in situ by means of the presented methodology.

Comparison of pulpal blood flow in dog canine teeth determined by the laser Doppler and the 133xenon washout methods

Pulpal blood flow measurements by laser Doppler flowmetry were compared with those made simultaneously and on the same teeth by the 133Xe washout method. Pulpal method flow in the resting state was 82.4 ml/min per 100 g as calculated from the fast component of the 133Xe washout, whereas laser Doppler flowmetry recorded 263 mV. The close intra-arterial (i.a.) injection of the vasoconstrictor norepinephrine (10(-2)-10(-1) micrograms/kg) caused a reduction of pulpal blood flow by 20.2% with the 133Xe washout and by 9.7% with the laser Doppler flowmetry in 6 observations in 4 dogs. The laser Doppler flowmetry measurements of these norepinephrine-induced changes correlated significantly with changes measured by the 133Xe washout method as analysed by linear regression (p = 0.004).