Effects of trigeminal tractotomy and of carbamazepine on single trigeminal sensory neurons in cats

Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases

Feline orofacial pain syndrome (FOPS) is a pain disorder of cats with behavioural signs of oral discomfort and tongue mutilation. This report describes the findings from a case series of 113 cats including 100 Burmese. FOPS is suspected to be a neuropathic pain disorder and the predominance within the Burmese cat breed suggests an inherited disorder, possibly involving central and/or ganglion processing of sensory trigeminal information. The disease is characterised by an episodic, typically unilateral, discomfort with pain-free intervals. The discomfort is triggered, in many cases, by mouth movements. The disease is often recurrent and with time may become unremitting - 12% of cases in this series were euthanased as a consequence of the condition. Sensitisation of trigeminal nerve endings as a consequence of oral disease or tooth eruption appears to be an important factor in the aetiology - 63% of cases had a history of oral lesions and at least 16% experienced their first sign of discomfort during eruption of permanent teeth. External factors can also influence the disease as FOPS events could be directly linked to a situation causing anxiety in 20% of cats. FOPS can be resistant to traditional analgesics and in some cases successful management required anti-convulsants with an analgesic effect.

Physiological Properties of neurons in different parts of the cat trigeminal sensory complex

The following points emerge from a systematic investigation of the 4 divisions of the cat trigeminal sensory complex. (1) The subnucleus oralis receives a large representation from the oral cavity, a region also represented in the 3 other divisions of the trigeminal sensory complex. (2) Nucleus principalis cells project heavily to the contralateral and to the ipsilateral ventroposterior thalamus. Ipsilateral projections are only from the oral cavity representation. (3) Units responding to noxious mechanical stimulation have been found at two different loci: the subnucleus caudalis for the entire trigeminal area, and subnucleus oralis for the oral cavity alone. (4) The dental pulp projects to the 4 divisions of the trigeminal sensory complex, but the heaviest projection was found in the rostral part (nucleus principalis and subnucleus oralis). (5) Three distinct types of post-synaptic responses were found to be evoked by dental pulp stimulation: (a) short latency, consistent and synaptically secure, (b) strongly variable latency, inconstant and easily fatigued and (c) a class showing progressive enhancement by progressive increase in stimulus intensity and repetition.

Projection of tooth pulp afferents to the brainstem and to the cortex in the cat

The projection of tooth pulp afferents in the spinal trigeminal nucleus (N.V.sp.) and the effect of dorsolateral medullotomy on cortical potentials evoked by electrical stimulation of Adelta tooth pulp nerve fibres were studied in cats. It was confirmed that antidromic responses were recorded in the tooth pulp nerve to stimulation of the ipsilateral but not the contralateral N.V.sp.[11]. Dorsolateral medullotomy at the level of the obex did not alter the cortical potentials induced by single pulses applied to the tooth pulp. It is concluded that Adelta tooth pulp afferents project exclusively to the ipsilateral trigeminal nucleus and that the impulse transmission to the cortex persists after transection of the pars caudalis of the N.V.sp.

Effect of trigeminal tractotomy on behavioral response to dental pulp stimulation in the monkey

Trigeminal tractotomy near the level of the obex was carried out in 10 macaque monkeys. Behavioral responses were evaluated by a quantitative paradigm measuring lever-press responses to electrical stimulation of the dental pulp or facial skin, and by assessing facial response to cutaneous pin-scratch before and after the tractotomy. Two pharmacological agents, strychnine and L-dopa, were administered and their effect on behavioral responses to these stimuli was studied. Tractotomy did not produce dental analgesia. Thresholds for escape from cutaneous electrical stimulation of facial skin, however, were elevated, consistent with marked hypalgesia to pin-scratch. The adversive responses to pin-scratch were absent in peripheral portions of the face, but near the midline and inside the oral cavity they were usually decreased or normal. Pharmacological agents caused a reduction in escape thresholds to cutaneous electrical stimulation and a shrinkage or abolition of the zone of analgesia to pin-scratch. The results imply that trigeminal nucleus caudalis, which undergoes deafferentation by tractotomy, may not be essential for processing of nociceptive information from the teeth, oral cavity, and midline facial zones. This findings is contrary to long-held hypotheses concerning facial pain mechanisms. The ability of strychnine and L-dopa to alter nociceptive escape thresholds is consistent with the idea, suggested by Denny-Brown, that facial nociception depends on central summation in the entire spinal trigeminal nucleus from overlapping afferent inputs contained in the trigeminal nerve, other cranial nerves, and the upper cervical nerve roots.

Evaluation of fluoride prophylaxis pastes

The fluoride (F) uptake from two commercial prophylaxis pastes and a newly formulated prophylaxis paste was compared. The enamel fluoride uptake of 26 extracted sound human molars was measured using an acid etch biopsy method. The F uptakes in ppm (mean +/- SEM) for the control prophy pastes (C), Zircate treatment paste (Z), an APF paste (Nuppro,A), and a new experimental paste (N) were 1145 +/- 65,1245 +/- 72,1857 +/- 296, and 1841 +/- 321, respectively. The enamel biopsy depths in micrometers (mean +/- S.D.) for the control, Zircate APF pastes, and Newpaste were 6.64 +/- 1.75, 7.4 +/- 2.32, 6.55 +/- 2.23 and 7.69 +/- 1.80. The Newpaste appeared to give a significantly higher fluride uptake than Zircate and control pastes, but was very similar to an APF paste.

Relationship between dental caries experience and surface enamel fluoride concentration in young men from three optimally fluoridated cities

An in vivo enamel biopsy technique was used to determine relationships between dental caries experience and surface enamel fluoride levels in a group of young men from three fluoridated cities on the east coat of the U.S. A significant inverse relationship between enamel thickness and fluoride concentration was observed, and a weak but statistically significant inverse relationship between caries scores and enamel fluoride concentration was noted. The effect was most pronounced in biopsies which did not exceed 5.9 micron in depth.

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.

Inputs to trigeminal brain stem neurones from facial, oral, tooth pulp and pharyngolaryngeal tissues: II. Role of trigeminal nucleus caudalis in modulating responses to innocuous and noxious stimuli

Trigeminal (V) tractotomy and cold block of synaptic transmission in V nucleus caudalis were used to show that caudalis modulates the responses to innocuous and noxious stimuli of single V main sensory-oralis neurones recorded in anaesthetized or decerebrate cats. Cold block caused a reversible depression of mechanosensitivity of 91 of 105 V-thalamic relay and non-relay cells tested; V tractotomy also decreased sensitivity. The possibliity that the effects observed with cold block of caudalis were caused by direct spread of cooling to the main sensory-oralis region, and not by depression of a tonic, net facilitatory influence of caudalis on main sensory-oralis cells, was ruled out by several controls. With cold block of caudalis there also occurred a reversible shrinkage in mechanoreceptive field size and reversible reduction in sensitivity of rapidly adapting and slowly adapting mechanoreceptive neurones. Occasionally no change or an increase in sensitivity occurred, the latter suggesting the liklihood of an inhibitory influence from caudalis as well as the facilitatory influence. The effects of interactions of innocuous and noxious V stimuli were likewise subject to ascending influences from caudalis. Cold block also reversibly depressed responses to tooth pulp and V cutaneous noxious stimuli, although pulp-evoked responses were depressed less than mechanical or infraorbital nerve-elicited responses. Our results indicate that caudalis, as well as acting as a relay site to thalamus, also exerts a predominantly facilitatory influence on the relay to the thalamus and local reflex centres of mechanoreceptive and nociceptive information through the V main sensory-oralis region. The findings also might in part explain the analgesia, partial loss of tactile sensibility, and relief from V neuralgia reported after V tractotomy.

A new abrasive applicator for human enamel biopsy procedures

Experiments were performed that demonstrated that the felt cylinder usually used to obtain abrasive biopsy specimens did not uniformly remove enamel from rounded or irregular enamel surfaces in the window area. A foam-silicone rubber laminate was developed to replace the felt cylinder. This resulted in greater uniformity of abrasion over the enamel surface within the biopsy window area and better operator handling characteristics.

Effects of titanium tetrafluoride on human enamel

Acid etch biopsy specimens of human enamel surfaces treated with a TiF4 solution have shown fluoride uptake to be significantly greater than in untreated surfaces, but less than that obtained with an APF solution of the same fluoride concentration. The TiF4 treated surfaces, however, do show a statistically significant reduction in the acid solubility of the enamel. The presence of acid-resistant coating was shown by SEM.