Michael L. Ahlquist

Perception of pulpal pain as a function of intradental nerve activity

&NA; The purpose of the present investigation was to find neurophysiological correlates of pain perception. The magnitude and time course of perceived pain was successfully related to the neural discharge evoked by rapid cooling of the tooth surface in 6 dental patients whose lower incisors were to be extracted for prosthodontic reasons. Two cavities were prepared on the facial surface of human lower incisors. The cavities were deepened using hand driven instruments until the pulp was visible through a thin layer of dentin. A metal tube was placed in contact with amalgam on each cavity bottom and fixed in place by composite filling material. The tubes were connected to standard equipment for electrophysiological recordings by a flexible circuit. The magnitude of perceived pain was assessed by a cross‐modality matching to finger span in combination with sensory verbal pain descriptors and magnitude estimation. The striking agreement between the integrated nerve activity, probably of the A&dgr; type and pain perception, is of great importance from the methodological point of view since it strongly argues in favor of the appropriateness of the techniques applied here to elucidate the neural substrate of some types of nociception and also to evaluate various means of relieving such pain.

Dental Pain Evoked by Hydrostatic Pressures Applied to Exposed Dentin in Man: A Test of the Hydrodynamic Theory of Dentin Sensitivity

The hydrodynamic theory of dentin sensitivity holds that pain is evoked by stimuli producing minute shifts in tubule fluid. In human volunteers hydrostatic pressures were applied to prepared dentinal cavities. The subjects reported the magnitude and quality of their sensations of pain by means of an intermodal matching technique in combination with verbal descriptors. No pain could be elicited when the smear layer was present. After removal of this layer, pressure stimuli of either direction evoked sharp pain. Rapid changes in pressure induced higher pain intensities than slow changes, indicating that the dental A-delta system is dynamic and gradient dependent. These results provide support for the hydrodynamic theory of dentin sensitivity and also lend credence to the notion that the movement of fluid across dentin induces a selective activation of the A-delta nerves in healthy pulps which is highly correlated with a sensation of sharp and/or shooting pain.

Relation between intradental nerve activity and estimated pain in man--a mathematical model.

Abstract Intradental nerve activity (INA) induced by cold stimulation of human teeth is regularly accompanied by pain perception. In this study a mathematical model was developed in order to quantify the relationship between INA and pain. In 5 patients (45 experiments) INA was recorded using electrodes implanted in lower incisor teeth. Brief cold stimulations induced bursts of INA. The intensity of the resulting pain was simultaneously evaluated by means of an intermodal matching technique, finger span. The relationship between perceived pain and the integrated INA was analyzed using various mathematical operations (inter alia Fourier analysis) by means of a computer. A transfer function which describes the pain response following INA was found. This preliminary mathematical model, which is characterized by 5 parameters, consists of 2 parts, one which responds to fast changes in the afferent nerve signal, and another which reacts with a delay. The validity of the model has been tested, and it was found that the model consists of an adequate number of parameters and their cross‐interaction is low. The analysis indicates that the parameters which determine the pain response following INA can be quantified and that they might be used as a measure of the efficacy of various pain relieving procedures.

The intensive aspect of information processing in the intradental A-delta system in man—a psychophysiological analysis of sharp dental pain

The tooth pulp has many attractive features for the study of peripheral pain mechanisms because of its rich innervation, its unique distribution of nerve fibers and its general disposition to give rise to pain upon stimulation. An experimental model has been developed for simultaneous recordings of intradental multi-unit A-delta nerve activity and the subjective intensity and quality of pain evoked by tooth pulp stimulation in conscious, alert humans. The only teeth to be considered for this kind of investigations are those having such a periodontal condition that they have to be extracted. The nerve activity was recorded from two electrodes placed in the dentin on the labial tooth surface, one at the level of the most incisal part of the pulp, and the other as far apically as possible. Brief cold stimulation was produced by using evaporating ethyl chloride administered between the recording electrodes. The magnitude of perceived pain was estimated by means of an intermodal matching technique (finger span) in combination with verbal descriptors. Of three response criteria selected--average response amplitude, peak amplitude and area under the response curve (integral)--for describing the relationship between intradental nerve activity and sharp, shooting pain, the integral yielded the highest mean correlation coefficient.

Efficacy of 3 Different Irrigation Systems on Removal of Calcium Hydroxide from the Root Canal: A Scanning Electron Microscopic Study

INTRODUCTION The purpose of this study was to evaluate the effectiveness of different irrigation systems on removing calcium hydroxide (Ca[OH]2) from the root canal by using a scanning electron microscope. METHODS Forty extracted single-rooted teeth were divided randomly into 4 groups. Canal instrumentation was done, and the teeth were filled with Ca(OH)2 paste. One week later, 4 techniques were used for Ca(OH)2 removal. In the first group, the canals were cleaned with a master apical file. The second, third, and fourth groups were irrigated using the EndoVac (Discus Dental, Culver City, CA), EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK), and ProUltra (Dentsply Tulsa, Tulsa, OK) systems, respectively. All the groups were irrigated with 3 mL (18%) EDTA and 3 mL (1%) NaOCl for 1 minute. The canal walls were viewed, and the remaining amount of Ca(OH)2 was evaluated using a scanning electron microscope. A scoring system was used to assess the amount of residue Ca(OH)2 on each third of the canal. The obtained data for comparisons between the conventional irrigation needle and each device were statistically analyzed using the Mann-Whitney U test. RESULTS To compare the 4 devices, the results were statistically analyzed using the analysis of variance test. CONCLUSIONS None of the investigated techniques removed the Ca(OH)2 dressing completely. However, the EndoActivator System showed better results in removing Ca(OH)2 in each third of the root canals in comparison with the other techniques.

Evaluation of a mathematical model analysing the relation between intradental nerve impulse activity and perceived pain in man

In this investigation the usefulness and accuracy of the parameters of a mathematical model for the analysis of the effectiveness of different pain relieving procedures on pulpal pain were studied. The investigation was carried out using a previously developed mathematical/biological model on data from original subject recordings of Intradental Nerve Impulse Activity (INA) and pain estimations. Computer simulated INA and pain estimation curves were also used to enable calculation of the mathematical and biological conditions that are essential for the actual mathematical/biological model, and to facilitate the interpretation of the parameters of the model. It was shown by means of both real and simulated data that the mathematical model is well suited for the analysis of the effectiveness of some pain relieving procedures on pulpal pain. It was also shown that, by means of three new variables, the model could be made even more accurate and useful for this application.