Pain of the Dental Origin Flashcards
(29 cards)
what are the types of dental pain?
thermal/cold/heat
spontaneous
sweets
mastication
sharp/dull
continuous/intermittent
specific times of the day
what are the two types of pain and when do they occur?
pulpal pain: due to thermal, sweets or spontaneous pain
periapical pain: due to spontaneous, mastication or pressure
what types of things can cause pain?
swelling and inflammation
why is pain an unreliable indicator of the state of the pulp?
there is poor correlation between the degree of tissue destruction (pathology) and the presence or absence of pain (symptomatology)
how is pain subjective?
patients can have variabilities in pain thresholds, physiological factors like anxiety and fear leading to increased pain or neurological processing differences
how does the distribution of nerve fibers lead to poor localization of pain?
Each tooth is supplied by afferent nerve fibers from the trigeminal nerve which branch and may supply multiple teeth, leading to overlapping nerve signals
what is axonal reflex?
When a tooth is stimulated by decay, trauma, or infection, the nerve sends a signal to adjacent nerve branches causing neurogenic inflammation (release of chemicals) in nearby teeth, even if they are not directly affected which results in neighboring teeth pain, making it difficult to pinpoint which tooth is the actual source of pain
what is the distribution of nerve fibers in the pulp proper?
- approx. 2000 fibers enter each root apical foramen
- approx. 80% are unmyelinated
- approx. 40% of tubules at pulp horns receive nerve fibers (less in other regions)
- fibers enter into tubules for approx. 100um
what are the types of nerve fibers found in the pulp?
- Aβ, Aδ-f, Aδ-s, and C fibers
where are most A fibers located? C Fibers?
- odontoblastic processes and coronal part of the pulp
- pulp proper
what is the location of the terminals, pain characteristics and stimulation threshold for Aβ fibers?
- dentin, predentin
- sharp, pricking
- low (hydrodynamic receptors)
what is the location of the terminals, pain characteristics and stimulation threshold for Aδ fibers?
- dentin, predentin, odontoblastic layer
- sharp, pricking
- relatively low
what is the location of the terminals, pain characteristics and stimulation threshold for C fibers?
- throughout the pulp
- dull, aching less bearable than Aδ and Aβ sensations
- relatively high associated with tissue injury
what is the hydrodynamic theory of dentin sensitivity?
external stimuli (like cold, heat, air, or pressure) cause fluid movement inside the tubules, it disturbs the nerve endings in the pulp triggering pain signals to be sent to the brain
how can the hydrodynamic stimulus cause C fiber activation?
If fluid movement inside tubules is intense or prolonged it can lead to inflammation in the pulp (pulpitis) causing increased intrapulpal pressure and vascular changes like release of inflammatory mediators which causes the stimulation of C fibers
what signals cold pain in teeth?
Cold lowers the temperature of dentinal fluid, causing it to contract and move which mechanically activates TRPC5 channels in odontoblasts, allowing calcium ions (Ca²⁺) to flow into the cells leading to signal transmission to underlying nerve fibers (A-delta and C fibers)
what are the characteristics of pulpal inflammation?
- vasodilation, circulatory statis, hemorrhage and edema
- infiltration of lymphocytes, plasma cells and mobilization of macrophages
- microabscess formation, more neutrophils, local destruction of odontoblast layer, fusion of multiple microabscesses and localized liquefaction of necrosis
what are the three ways an inflamed periapical area occurs?
- periapical abscess
- overinstrumentation
- chronic periapical inflammatory lesion
what is one of the main causes of pain in an inflammed periapical area?
the pressure build up from the inflammation
what are the areas that can become inflamed if a periapical abscess is not treated?
- sublingual space in sublingual tissue above mylohyoid muscle
- submandibular space below mylohyiod muscle
- buccal space between buccinator and overlying skin
- maxillary sinus
- palate
- under the tongue
what is cracked tooth syndrome?
A set of signs and symptoms emanating from an incomplete crack into the dentin of a vital tooth without pulp exposure
what are the characteristics of cracked tooth syndrome?
A momentary lancinating pain that occurs as occlusal forces are initiated and released during chewing (rebound tenderness)
what are the causes of cracked tooth syndrome?
The micromovement causes pulpal stimulation through the dentinal tubules, resulting in pain
what is barodontalgia?
Dental pain related to barometric pressure changes
