CORRELATION BETWEEN CLINICAL PAIN & PULP NEUROBIOLOGY

 

CLINICAL CONDITION HISTOLOGICAL PICTURE
Hypersensitive exposed dentin Elevated number of nerve fibers in underlying pulp and dentin (“nerve sprouting” occurs in response to inflammatory stimuli).
Silent Pulpitis Fibrotic changes in pulp forms a barrier between the lesion & the nerve fibers.
Co-existence of vital pulp & periapical lesions May be caused by CGRP nerve sprouting à neuropeptides released à effect of neuropeptides on bone and periapical tissues.
Difficult anesthesia for inflamed teeth Elevated number of nerve fibers adjacent to the area of inflammation à if cytochemical changes in the affected nerve fibers extend all the way upto the ganglion à leads to reduced efficacy of nerve block anesthesia.
Episodic toothache Depends on cycles of tissue destruction, with adjacent nerve sprouting, followed by local healing with fibrous sequestration of the lesion, creating a barrier between inflammation and nerve fibers.

[From: Inoki R, Kudo T, Olgart LM. Dynamic aspects of dental pulp. Cambridge, Great Britain: Chapman and Hall. 1990.

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