N.P. Kerezoudis

Differential effects of nitric oxide synthesis inhibition on basal blood flow and antidromic vasodilation in rat oral tissues.

The role of nitric oxide in the mediation of (a) antidromic and (b) substance P-induced vasodilation in the pulp, lip, oral mucosa and submandibular gland was investigated in anaesthetized rats by means of laser Doppler flowmetry. Bolus or continuous infusion of N omega-nitro-L-arginine methyl ester (L-NAME) increased mean arterial blood pressure and reduced basal blood flow in the pulp but not in the lip. Electrical stimulation of the inferior alveolar nerve, in the presence of phenoxybenzamine, resulted in a long lasting vasodilation in lower lip and incisor pulp. Infusion of L-NAME enhanced the antidromic vasodilation in both lip and pulp. Pretreatment with L-arginine prevented these effects. Administration of the enantiomer (D-NAME) did not exert any effect on basal blood flow and on antidromic vasodilation. Infusion of substance P resulted in a transient vasodilation in all of the oral tissues studied. L-NAME reduced this vasodilation in the submandibular gland (only the lower doses) but it potentiated the responses in the pulp and oral mucosa. Pretreatment with L-arginine prevented the potentiated responses in the pulp and those induced by the lower doses of substance P in the oral mucosa. Thus, nitric oxide appears to differentially regulate the basal blood flow and the antidromic or substance P-induced vasodilation in the microvasculature of the lip and dental pulp.

Nerve-pulp interactions

Pulpal haemodynamics are naturally intermeshed with inflammatory responses. Cellular and humoral factors may be the vehicles that aid in physiological regulation, but when these systems are overly activated, they may lead to pathological changes. Sensory nerves may initiate inflammatory reactions when activated, and interestingly, recent findings show that vasoconstrictor nerves in the pulp can inhibit the release of neurally stored vasoactive and inflammatory mediators. Thus, there are options for endogenous control of inflammation. Perhaps a variation in the effectiveness of such control can explain why symptoms of hypersensitivity and pain are so unpredictable and individual. What naturally occurring agents are involved in early tissue changes and how do they act? Some agents exert their effects both on vessels and nerves. Thus, there is an intriguing mutual interplay between nerves and tissue reactions. A prolonged, painful stimulation may generate increased blood flow and inflammation, and vice versa, inflammation may lead to pain. This complexity of mechanisms generates many questions that need answers.

Evans blue extravasation in rat dental pulp and oral tissues induced by electrical stimulation of the inferior alveolar nerve.

Whether increased extravasation of plasma protein may occur in the rat incisor pulp as a result of antidromic stimulation of afferent nerves was investigated, and this preinflammatory reaction compared with that in adjacent soft tissues. In anaesthetized rats, the inferior alveolar nerve was exposed and stimulated electrically (10-15 V, 2 ms, 10 Hz for 30 s or 5 min). Blood flow changes in the lower lip and incisor pulp were recorded by laser Doppler flowmetry. Increased vascular permeability in the lip, gingiva and pulp was indirectly determined by means of the Evans blue dye method and spectrophotometric analysis. Stimulation of the inferior alveolar nerve for 30 s, in the presence of the alpha-adrenergic blocker phenoxybenzamine (3 mg/kg), increased blood flow in the lip by 172 +/- 16% and in the pulp by 38 +/- 5% as compared to basal blood flow. Intravenous (i.v.) administration of atropine (1 mg/kg), chlorisondamine (3 mg/kg), timolol (150 micrograms/kg), cimetidine plus mepyramine (3 mg/kg of each), methysergide (1 mg/kg) and diclofenac sodium (3 mg/kg) was without effect on this response. Acute pretreatment with capsaicin (1-3 mg/kg, i.v.), however, abolished the vasodilation in the pulp and reduced that in the lip by 58% (p < 0.05). In untreated animals, stimulation of the inferior alveolar nerve for 5 min increased the Evans blue content in the ipsilateral lip by 164% (p < 0.001), gingiva by 55% (p < 0.01) and pulp by 67% (p < 0.01). Pretreatment (i.v.) with a combination of cimetidine and mepyramine counteracted the dye extravasation only in the gingiva.(ABSTRACT TRUNCATED AT 250 WORDS)

Activation of sympathetic fibres in the pulp by electrical stimulation of rat incisor teeth

Previous studies of the sympathetic nerve supply of the rat mandibular incisor pulp have shown conflicting results. Here, the neurovascular control of the rat lower incisor pulp was investigated by stimulating the tooth crown and the cervical sympathetic trunk electrically and monitoring blood-flow changes in the pulp by laser Doppler flowmetry. In addition the presence of noradrenaline (NA) in the pulp and gingiva was examined biochemically in untreated and sympathectomized animals by high-performance liquid chromatography. The tissue concentrations of NA in the pulp were 11-fold greater than those of gingiva. Surgical sympathectomy significantly reduced the NA content in the pulp by 76%. Monopolar electrical stimulation of teeth (25-50 microA) for 1 min resulted in a frequency-dependent reduction followed by an increase in pulpal blood flow. At 16 Hz the reduction in blood flow was 65% and the subsequent increase was 9%. After intravenous administration of the alpha-adrenoceptor antagonist phentolamine, the stimulation-induced reduction in pulpal blood flow was diminished by 94% while the increase was significantly enhanced (from 9 to 40%). Infusion of the beta-adrenoceptor antagonists propranolol and timolol significantly reduced this increase in blood flow by 53 and 55%, respectively. Preganglionic sympathetic nerve stimulation also induced a frequency-dependent reduction followed by a slight increase in pulpal blood flow. This reduction in blood flow was almost abolished after alpha-adrenergic blockade and there was no subsequent increase. These findings suggest that there are sympathetic nerve fibres in rat incisor pulp and that they are activated upon monopolar electrical stimulation of teeth resulting in alpha- and beta-adrenoceptor mediated blood-flow responses.

Involvement of substance P but not nitric oxide or calcitonin gene-related peptide in neurogenic plasma extravasation in rat incisor pulp and lip

The possible involvement of the neuropeptides substance P and calcitonin gene-related peptide (CGRP) in the development of neurogenic plasma extravasation in the lower lip, gingiva and incisor pulp was examined in anaesthetized rats by means of the Evans blue method and by using newly developed blockers of substance P (CP-96,345) and CGRP (CGRP8-37). Electrical stimulation of the inferior alveolar nerve (15 V, 2 ms, 10 Hz) for 5 min significantly increased the Evans blue content of the ipsilateral lip, gingiva and pulp by 60 (p < 0.01), 62 (p < 0.01) and 92% (p < 0.05), respectively (n = 8). Pretreatment with CP-96,345 (total dose: 1.5 mg/kg, intravenously) counteracted the dye leakage in the lip and pulp but not in the gingiva (n = 6). The inactive enantiomer (CP-96,344, 1.5 mg/kg, n = 8) or the nitric oxide synthesis inhibitor (N omega-nitro-L-arginine methyl ester hydrochloride, 10 mg/kg, n = 7) did not reduce the stimulation-induced dye extravasation in any of the tissues. Pretreatment with CGRP8-37 (0.3 mg/kg, n = 7) did not significantly influence the development of neurogenic extravasation in the lip and incisor pulp, but it slightly attenuated extravasation in the gingiva. The results indicate that the afferent nerve-induced dye extravasation in the lip and pulp, but not in the gingiva, is to a large extent mediated by substance P acting via neurokinin-1 receptors. There was no evidence for an involvement of nitric oxide or CGRP in neurogenic extravasation in rat incisor and lip.

Inhibitory influence of sympathetic nerves on afferent nerve-induced extravasation in the rat incisor pulp upon direct electrical stimulation of the tooth

Previous studies have shown that sympathetic nerve stimulation reduces afferent nerve-induced vasodilation by mechanisms unrelated to vasoconstriction in the rat incisor pulp. The present investigation concerned whether similar modulatory mechanisms might also influence neurogenic plasma extravasation in dental pulp. Rat mandibular incisors were electrically stimulated and blood flow reactions in the pulp were recorded by laser Doppler flowmetry. Plasma extravasation in the incisor pulp, gingiva and lip were indirectly assessed by the Evans-blue method. Stimulation of teeth with 50 microA (5 min) did not cause increased dye accumulation in the stimulated pulps whereas stimulation with 100 microA significantly increased the dye content in ipsilateral pulps by 32% as compared to controls; 100 microA stimulation was without effect in unilaterally denervated animals. Tooth stimulation with 50 microA (5 min), in the presence of either the alpha-adrenergic blocker phenoxybenzamine (3 mg/kg), or the alpha 1-adrenergic antagonist prazosin (50 micrograms/kg), as well as in chronically sympathectomized animals, significantly increased the Evans-blue content in the stimulated pulps by 47, 83 and 86%, respectively. Application of short trains of impulses (same number of impulses as for the continuous stimulation but producing minimal vasoconstriction) resulted in some dye accumulation, which was enhanced in the ipsilateral pulps in the presence of prazosin (100 micrograms/kg) or after acute resection of the superior cervical sympathetic ganglion by 70 and 64%, respectively. The Evans-blue content in the lip and gingiva was uninfluenced by the tooth stimulation. The results indicate that activation of sympathetic nerves inhibits the afferent nerve-induced plasma extravasation in rat incisor pulp and this effect is mediated by alpha-adrenoceptors not associated with vasoconstriction.

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.