Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study.

OBJECTIVE: To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. DESIGN: Retrospective. SETTING: Single institutional study. PATIENTS: Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. INTERVENTION: The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). MAIN OUTCOME MEASURES: Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. RESULTS: Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA (p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group (p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group (p = 0.04, Mann-Whitney's U-test). CONCLUSIONS: The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.

Lateral Approach With a Mouth Corner Incision for the Molar Part of Mandibulectomy.

OBJECTIVES: The aim of the present study was to evaluate the functional and esthetic results of marginal mandibulectomy for mandibular cancer using a lateral approach with a simple, straightforward mouth corner incision. STUDY DESIGN: Six mandibular cancer patients (2 men, 4 women; age range: 65-80 years; mean age, 73.1 years; all stage I) were treated using this approach. With this approach, the surgical field was widely exposed, and mandibulectomy was performed with sufficient surgical margins. Intraoperative frozen specimens of remaining tissues showed no malignancy in all cases. In all 6 patients, follow-up imaging assessments were obtained, with no local recurrence after 12 to 78 months. RESULTS AND CONCLUSIONS: An overall functional, physical, and esthetic assessment of oral behavior and oral appearance was made of all patients by the FACT-H&N questionnaire, which showed that functional lip behavior and esthetic lip appearance were not much affected by the present surgical approach, and good quality of life was maintained. Thus, the lateral approach with the mouth corner incision is an effective and useful alternative for the molar part of mandibulectomy.

Neuropeptide Y modulates membrane excitability in neonatal rat mesencephalic V neurons.

Neuropeptide Y (NPY) is one of a number of neuropeptides with powerful orexigenic effects. Intracerebroventricular administration of NPY induces increases in food intake and alters feeding rate. Besides it role in feeding behavior, NPY also has significant effects on neuronal systems related to other spontaneous behaviors such as rearing and grooming. In the present study, we examined the direct effects of NPY on mesencephalic V neurons (Mes V), which are important sensory neurons involved in oral motor reflexes and rhythmical jaw movements, as well as masticatory proprioception. Coronal brain slices were prepared from neonatal Sprague-Dawley rats (P3-17) and whole-cell patch clamp recordings were obtained from Mes V neurons. Bath application of NPY depolarized the membrane potential and induced inward current in most neurons. Application of NPY shortened the duration of the afterhyperpolarization following an action potential, and increased the mean spike frequency during repetitive discharge. In those neurons which exhibited rhythmical burst discharge in response to maintained current injection, the bursting frequency was also increased. These effects were mediated predominately by both Y1 and Y5 receptors.

A fungal ball within a maxillary sinus with dental root canal filler and rare fungal propagules.

A fungal ball of a maxillary sinus sometimes includes dental treatment-related foreign material because the sinus is close to the root of the upper teeth. We present a case of right maxillary sinus fungal ball with a gutta-percha point, a dental root canal filler. X-ray analysis of the foreign material in the paraffin section of the fungal ball successfully detected zinc, sulfur, and barium, all of which were constituents of the gutta-percha point. The gutta-percha point might have facilitated the formation of the fungal ball through disruption of the sinus-clearing mechanism. Another interesting histological feature of the fungal ball was the finding of calcium oxalate crystals and non-hyphal fungal elements such as cleistothecia, Hülle cells, and conidial heads. This is the first report of such a combination being found in a specimen of human fungal disease. Although fungal culture was not available in the present case, molecular analysis of the formalin-fixed paraffin-embedded tissue of the fungal ball succeeded in revealing only DNA sequences of Aspergillus nidulans and some other environmental Aspergillus spp.

Development of resurgent and persistent sodium currents in mesencephalic trigeminal neurons.

Sodium channels play multiple roles in the formation of neural membrane properties in mesencephalic trigeminal (Mes V) neurons and in other neural systems. Mes V neurons exhibit conditional robust high-frequency spike discharges. As previously reported, resurgent and persistent sodium currents (INaR and INaP , respectively) may carry small currents at subthreshold voltages that contribute to generation of spike firing. These currents play an important role in maintaining and allowing high-frequency spike discharge during a burst. In the present study, we investigated the developmental changes in tetrodotoxin-sensitive INaR and INaP underlying high-frequency spike discharges in Mes V neurons. Whole-cell patch-clamp recordings showed that both current densities increased one and a half times from postnatal day (P) 0-6 neurons to P7-14 neurons. Although these neurons do not exhibit subthreshold oscillations or burst discharges with high-frequency firing, INaR and INaP do exist in Mes V neurons at P0-6. When the spike frequency at rheobase was examined in firing Mes V neurons, the developmental change in firing frequency among P7-14 neurons was significant. INaR and INaP density at -40 mV also increased significantly among P7-14 neurons. The change to an increase in excitability in the P7-14 group could result from this quantitative change in INaP. In neurons older than P7 that exhibit repetitive firing, quantitative increases in INaR and INaP density may be major factors that facilitate and promote high-frequency firing as a function of age in Mes V neurons.

Effectiveness of an Interdisciplinary Medical Hospital Admission Center: The Role of the Dental Section in the Interdisciplinary System for Perioperative Management of Patients Awaiting Surgery.

Perioperative oral functional management (POFM) involves total oral management of a patient before surgery. Considerable benefits have been reported, but POFM remains scarce in medical settings. An interdisciplinary Medical Hospital Admission Center (MHAC) opened in our hospital in December 2014, and has since provided unified perioperative management for patients. This study reports on the clinical system and contributions of the systematized, standardized POFM applied through the MHAC. Patients awaiting surgery undergo oral screening before admission, with patients classified into three groups: red, needing surgical oral management (tooth extraction or other oral surgery) before surgery; yellow, needing non-surgical oral management before surgery, due to the planned surgery or the risk of tooth injury in connection with general anesthesia; or green, patients with good oral hygiene considered capable of suitable oral self-management. Patients categorized as red or yellow undergo POFM in the dental section of the MHAC before surgery. Almost all patients (88.8%) awaiting surgery now undergo preoperative oral screening, excluding emergent surgeries. In addition, oral screening is important for preventing tooth injury during endotracheal intubation for general anesthesia, and a need for preventive measures was identified in 6.1% of patients. No traumatic injuries of the teeth in connection with general anesthesia have occurred since the opening of the MHAC. Standardized POFM through an interdisciplinary MHAC thus seems extremely useful.

Influences of FLU/BU and FLU/MEL on incidence and severity of oral mucositis among allogeneic hematopoietic stem cell transplantation patients.

In the present study, we compared the incidence and severity of oral mucositis among patients undergoing allogeneic hematopoietic stem cell transplantation after fludarabine-based regimens with busulfan 12.8 mg/kg (FB12.8), with busulfan less than or equal to 9.6 mg/kg (FB9.6), and with melphalan 140 mg/m2 (FM). The incidence of oral mucositis after FB12.8 was the highest among these 3 groups. After FM, all of the patients had developed oral mucositis by day 7. The mean disease duration of oral mucositis after FB12.8 was 13.5 days, whereas the mean disease duration after FM was 24.9 days, and was significantly prolonged as compared to that after FB12.8 (p=0.0009). The incidence of severe oral mucositis (grade 3) after FM was significantly higher than that after FB12.8 (p=0.03). As stated above, although the incidence of oral mucositis after FB12.8 was higher than that after FM, oral mucositis after FB12.8 showed improvement relatively quickly without deterioration. In contrast, the higher incidence of severe oral mucositis and the delay in resolution of mucositis after FM were remarkable.

Tongue cancer with mental retardation due to microcephaly: a clinical report.

Oral cancer in patients with mental retardation has not been reported in detail, although the literature on clinical management of oral malignancies in the general population is extensive. No clear consensus has been established regarding the management of oral cancer in patients with mental retardation. We present herein the case of a 32-year-old Japanese man with mental retardation due to microcephaly who presented with advanced tongue cancer. He was treated with three courses of chemotherapy using superselective intra-arterial infusion of cisplatin at 100 mg/m2 via the femoral artery (Seldinger method). No major complications were encountered, and complete response was achieved. The patient has shown no clinical or radiological evidence of local recurrence or distant metastases as of 22 months after the end of treatment. This case provides a basis for the future appropriate management of oral cancer in patients with mental retardation.

Association between Toothbrushing and Cancer Risk.

Background: Most cancers are lifestyle-related and are thus preventable. Lifestyle habits can be improved by individual efforts; for example, because oral health is suggested to play a preventive role in cancer risk, toothbrushing is considered a critical and fundamental measure for controlling oral health. This study aimed to investigate the association between toothbrushing and cancer risk. Methods: Cross-sectional data from the Japan COVID-19 and Society Internet Survey, a large-scale (n = 32,000) online survey conducted in 2022, were used. From September 12 to October 19, 2022, questionnaires were distributed to candidates selected by simple random sampling from a Japanese Internet research company's panelists to represent the Japanese population. The association between toothbrushing and cancer risk according to cancer prevalence was then analyzed. Results: Among all 32,000 participants, 2,495 (7.8%) who had any cancer previously were analyzed. Multivariable logistic regression analysis revealed a significant association between toothbrushing habit and cancer risk. Conclusion: The findings of this study suggest that daily toothbrushing is essential for maintaining oral health and preventing cancer.

Swallowing-like activity elicited in neonatal rat medullary slice preparation.

Swallowing is induced by a central pattern generator in the nucleus tractus solitarius (NTS). We aimed to create a medullary slice preparation to elucidate the neural architecture of the central pattern generator of swallowing (Sw-CPG) and record its neural activities. Experiments were conducted on 2-day-old Sprague-Dawley rats (n = 46). The brainstem-spinal cord was transected at the pontomedullary and cervicothoracic junctions; the medulla was sliced transversely at thicknesses of 600, 700, or 800 µm. The rostral end of the slice was 100 µm rostral to the vagus nerve. We recorded hypoglossal nerve activity and electrically stimulated the vagus nerve or microinjected bicuculline methiodide (BIC) into the NTS. The 800-µm slices generated both rhythmic respiratory activity and electrically elicited neural activity. The 700-µm slices generated only respiratory activity, while the 600-µm slices did not generate any neural activity. BIC microinjection into the NTS in 800-µm slices resulted in the typical activity that closely resembled the swallowing activity reported in other experiments. This swallowing-like activity consistently lengthened the respiratory interval. Despite complete inhibition of respiratory activity, weak swallowing-like activity was observed under bath application of a non-NMDA receptor antagonist. Contrastingly, bath application of NMDA receptor antagonists resulted in a complete loss of swallowing-like activity and no change in respiratory activity. These results suggest that the 800-µm medullary slice preparation contains both afferent and efferent neural circuits and pattern generators of swallowing activity. Additionally, NMDA receptors may be necessary for generating swallowing activity. This medullary slice preparation can therefore elucidate Sw-CPG neural networks.

Is discontinuation of dental treatment related to exacerbation of systemic medical diseases in Japan?

Aims Since it is known that oral problems affect various medical diseases, the effects of restrictions on visits for dental treatment on exacerbations of various systemic medical diseases were examined.Method and materials The data were used from the Japan COVID-19 and Society Internet Survey, a large-scale internet survey conducted in 2021 (n = 28,175). The questionnaires were distributed to 33,081 candidates who were selected to represent the Japanese population regarding age, sex and residential prefecture using a simple random sampling procedure. Patients currently undergoing treatment for diabetes mellitus, hypertension, asthma, cardiocerebrovascular disease, hyperlipidemia, atopic dermatitis, and mental illness, such as depression, were extracted from the total participants. Then, whether discontinuation of dental treatment affected the exacerbation of their systemic disease was examined.Results Overall, 50-60% of patients with each systemic disease had continued to receive dental treatment, and 4-8% of them had discontinued dental treatment. On univariate and multivariate analyses, discontinuation of dental treatment is a risk factor in the exacerbation of diabetes mellitus, hypertensive conditions, asthma, cardiocerebrovascular disease and hyperlipidemia.Conclusion The present epidemiological study showed the relationship between oral health and systemic health, which can provide meaningful insights regarding future medical-dental collaboration in Japan.

Dental Treatment and Risk of COVID-19 in Japan.

PURPOSE: During the Coronavirus Disease 2019 (COVID-19) pandemic, there has been concern about nosocomial infections acquired through dental practice, where machines - such as air turbines - that generate aerosols are used, and where there are many opportunities to come into contact with saliva and blood. Because there is no report to date on whether dental treatment is associated with a risk of SARS-CoV-2 infection in Japan, the aim of the present cross-sectional study was to examine the risk of SARS-CoV-2 infection associated with dental treatment. MATERIALS AND METHODS: Cross-sectional data were gathered from the Japan COVID-19 and Society Internet Survey (JACSIS), a large-scale internet survey conducted in 2021 (n=28,175). From September 27, 2021, to October 30, 2021, the questionnaires were distributed to candidates selected from the panelists of a Japanese Internet research company to represent the Japanese population regarding age, sex, and residential prefecture using a simple random sampling procedure. The risk of SARS-CoV-2 infection related to dental treatment was examined and analysed. RESULTS: Multivariable logistic regression analysis showed that younger age, male sex and living alone were statistically significant factors positively associated with SARS-CoV-2 infection, whereas the presence or absence of dental treatment was not statistically significantly correlated with SARS-CoV-2 infection. CONCLUSION: The present epidemiological study showed that dental treatment is not a positive risk factor for SARS-CoV-2 infection in Japan.

Automatic identification of individuals using deep learning method on panoramic radiographs.

Abstract Background/purpose: The dentition shows individual characteristics and dental structures are stable with respect to postmortem decomposition, allowing the dentition to be used as an effective tool in forensic dentistry. We developed an automatic identification system using panoramic radiographs (PRs) with a deep learning method. Materials and methods: In total, 4966 PRs from 1663 individuals with various changes in image characteristics due to various dental treatments were collected. In total, 3303 images were included in the data set used for model training. Vgg16, Vgg19, ResNet50, ResNet101, and EfficientNet models were applied for identification. The precision curves were evaluated. Results: The matching precision rates of all models (Vgg16, Vgg19, ResNet50, ResNet101, and EfficientNet) were examined. Vgg16 was the best model, with a precision of around 80-90% on 200 epochs, using the Top-N metrics concept with 5-15 candidate labels. The model can successfully identify the individual even with low quantities of dental features in 5-10 s. Conclusion: This identification system with PRs using a deep learning method appears useful. This identification system could prove useful not only for unidentified bodies, but also for unidentified wandering elderly people. This project will be beneficial for police departments and government offices and support disaster responses.

Prognostic significance of the harmonized maximum standardized uptake value of 18F-FDG-PET/CT in patients with resectable oral tongue squamous cell carcinoma: a multicenter study.

OBJECTIVES: To investigate the usefulness of harmonized 18F-FDG-PET/CT parameters for predicting the postoperative recurrence and prognosis of oral tongue squamous cell carcinoma (OTSCC). METHODS: We retrospectively analyzed the cases of 107 OTSCC patients who underwent surgical resection at four institutions in Japan in 2010-2016 and evaluated the harmonized PET parameters of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for the primary tumor as the pSUVmax, pMTV, and pTLG. For lymph node metastasis, we used harmonized PET parameters of nodal-SUVmax, nodal-total MTV (tMTV), and nodal-total TLG (tTLG). The associations between the harmonized PET parameters and the patients' relapse-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox proportional hazard regression analysis for model 1 (preoperative stage) and model 2 (preoperative + postoperative stages). RESULTS: The harmonized SUVmax values were significantly lower than those before harmonization (p=0.012). The pSUVmax was revealed as a significant preoperative risk factor for RFS and OS. Nodal-SUVmax, nodal-tMTV, and nodal-tTLG were significant preoperative risk factors for OS. The combination of pSUVmax + nodal-SUVmax significantly stratified the patients into a low-risk group (pSUVmax <3.97 + nodal-SUVmax <2.85 or ≥2.85) and a high-risk group (pSUVmax ≥3.97 + nodal-SUVmax <2.85 or pSUVmax ≥3.97 + nodal-SUVmax ≥2.85) for recurrence and prognosis (RFS: p=0.001; OS: p<0.001). CONCLUSIONS: The harmonized pSUVmax is a significant prognostic factor for the survival of OTSCC patients. The combination of pSUVmax and nodal-SUVmax identified OTSCC patients at high risk for recurrence and poor prognosis at the preoperative stage.

Persistent sodium conductance contributes to orexin-A-mediated modulation of membrane excitability in neonatal rat mesencephalic V neurons.

Orexins are multifunctional hypothalamic neuropeptides that participate in the stimulation of feeding behavior and energy expenditure. However, little is known about their neuromodulatory effects in lower brainstem effector regions, including in the trigeminal neuronal system. The aim of this study was to examine the effects of orexin-A (Ox-A) on the membrane properties of mesencephalic trigeminal (Mes V) neurons that are critically involved in the generation and control of rhythmical oral motor activities. Whole-cell patch clamp recordings were obtained from Mes V neurons in coronal brain slices prepared from Sprague-Dawley rats (postnatal day 12-17). Bath application of Ox-A (100 nM) shortened the duration of the after-hyperpolarization following the action potential, while the interspike frequency of firings during repetitive discharge increased, together with a shift in the frequency-current relationship toward the left. In addition, Ox-A amplified the resonance at the depolarized membrane potential, accompanied with an increase in both Q-value and resonant frequency. A further voltage-clamp experiment demonstrated that Ox-A increased the peak current density of the persistent sodium current (INaP) and shifted its activation curve to the hyperpolarization direction. These results suggested that Ox-A may increase Mes V neuronal excitability by enhancing INaP, possibly sharing a common mechanism with another orexigenic hypothalamic neuropeptide, neuropeptide Y.

Orexins modulate membrane excitability in rat trigeminal motoneurons.

Orexins (Oxs) are multifunctional neuropeptides, secreted from the lateral hypothalamus, that stimulate feeding behavior and energy expenditure. In this study, the direct effects of Oxs on the membrane properties of trigeminal motoneurons (TMNs) were examined, which critically participate in the genesis of rhythmical oral motor activities underlying suckling and mastication. Sprague-Dawley rats (3-6 day-old) were used to obtain whole-cell patch-clamp recordings from TMNs. Bath application of Ox-A depolarized the membrane potential and induced inward current, wherein Na+ and Ca2+ were charge carriers. Transient receptor potential channel activation potentially contributed to current and voltage responses by way of Ox-A. Ox-A increased the peak amplitude and duration at half-amplitude of the medium-duration after hyperpolarization following the action potential. The interspike frequency of steady-state firings during repetitive discharge was increased, along with a shift in the frequency-current relationship occurring toward the left. Extracellular and intracellular Ca2+ were involved in regulating modulatory effects, but a requisite level of intracellular Ca2+ was not essential for Ox-induced upregulation of the interspike frequency. Ox-A also enhanced conditional bursting induced by N-methyl-d-aspartate and 5-HT, suggesting it participates in modulating TMNs' discharge patterns during various oral motor activities.

Large lingual heterotopic gastrointestinal cyst in a newborn: A case report.

BACKGROUND: Heterotopic gastrointestinal cysts have gastrointestinal epithelium in the cyst wall and rarely occur in the oral cavity. Most are found in the neonatal period. However, heterotopic gastrointestinal cysts that are diagnosed as a congenital tongue cyst by routine ultrasonography are extremely rare. CASE SUMMARY: A 12-day-old female presented with swelling of the anterior tongue. The obstetrician had detected significant tongue swelling on fetal ultrasonography in the 35th gestational week. The female was born by cesarean delivery at gestational week 39. She soon became dyspneic, and the cyst was aspirated. After the aspiration, her breathing recovered and she started breastfeeding. The cyst was excised under general anesthesia on the 67th day. Histopathologic examination showed that that cyst wall consisted of a lining of columnar gastrointestinal-type epithelium and pseudostratified ciliated epithelium. The patient restarted breastfeeding 3 h after surgery. The postoperative course was uneventful. CONCLUSION: Airway distress and feeding difficulty were successfully avoided by cyst aspiration, and surgical resection was performed with no perioperative complications.

Possible involvement of neurons in locus coeruleus in inhibitory effect on glossopharyngeal expiratory activity in a neonatal rat brainstem-spinal cord preparation in vitro.

In this study, we found that a certain motor branch of glossopharyngeal (IX) motor nerves stably exhibits not only inspiratory activity but also expiratory activity with pons removal in neonatal rat brainstem-spinal cord preparations in vitro. Because this finding indicates that IX expiratory activity is masked by an inhibitory mechanism operating in the pons, we sought to determine the candidate neurons that exert an inhibitory effect on IX expiratory activity. IX expiratory activity was observed when only the pons was perfused with noradrenaline (NA) or clonidine (alpha2 adrenergic receptor agonist), but not when NA and yohimbine (alpha2 adrenergic receptor antagonist) were perfused together. IX expiratory activity was also observed following the removal of the dorsal pons but not the ventral pons. The local administration of clonidine into the bilateral locus coeruleus (LC) evoked burst discharges during the expiratory phase in the IX motor rootlet. These results suggest that neurons in the LC that possess an alpha2 adrenergic receptor on the membrane surface exert a tonic inhibitory effect on IX expiratory activity in neonatal rat brainstem-spinal cord preparations.

High incidence of blood exposure due to imperceptible contaminated splatters during oral surgery.

PURPOSE: To evaluate the incidence of blood exposure during outpatient oral surgery from splattering caused by use of high-speed rotary instruments at the Referral and Teaching Center, University Dental Hospital. MATERIALS AND METHODS: Twenty-five consecutive patients who had impacted mandibular third molars were selected. The attending surgeon wore an operation gown and visor mask, and carried out the tooth extraction with the regular procedure. We counted the number of bloodstains found on the operation gown and visor mask, and confirmed the presence of diluted and invisible bloodstains using a leucomalachite green presumptive test, which was able to detect dilutions up to 1:4,000. RESULTS: There were 469 separate bloodstains on the gown and visor mask of oral surgeons, which came from 19 (76%) of 25 patients during impacted mandibular third molar surgery. Presumptive tests for invisible bloodstains resulted in 1,206 positive reactions, 2.57-fold greater than the visible stains, from 88% of the cases. All of the surgeons were right-handed and the common areas of staining were the right forearm, face, and thorax regions. CONCLUSIONS: Dental procedures with high-speed instruments exposed surgeons to possible blood-borne infections by splashing in nearly 90% of the cases. Greater than 50% of the stains were invisible to the naked eye. Based on our results, strict compliance with barrier precautions, including routine use of an operation gown and visor mask, is recommended whenever oral surgery is carried out with high-speed rotary instruments.

Participation of sodium currents in burst generation and control of membrane excitability in mesencephalic trigeminal neurons.

Subthreshold sodium currents are important in sculpting neuronal discharge and have been implicated in production and/or maintenance of subthreshold membrane oscillations and burst generation in mesencephalic trigeminal neurons (Mes V). Moreover, recent data suggest that, in some CNS neurons, resurgent sodium currents contribute to production of high-frequency burst discharge. In the present study, we sought to determine more directly the participation of these currents during Mes V electrogenesis using the action potential-clamp method. In postnatal day 8-14 rats, the whole-cell patch-clamp method was used to record sodium currents by subtraction in response to application of TTX in voltage-clamp mode using the action potential waveform as the command protocol. We found that TTX-sensitive sodium current is the main inward current flowing during the interspike interval, compared with the h-current (Ih) and calcium currents. Furthermore, in addition to the transient sodium current that flows during the upstroke of action potential, we show that resurgent sodium current flows at the peak of afterhyperpolarization and persistent sodium current flows in the middle of the interspike interval to drive high-frequency firing. Additionally, transient, resurgent, and persistent sodium current components showed voltage- and time-dependent slow inactivation, suggesting that slow inactivation of these currents can contribute to burst termination. The data suggest an important role for these components of the sodium current in Mes V neuron electrogenesis.