Effects of Two Different Anesthetic Solutions on Injection Pain, Efficacy, and Duration of Soft-Tissue Anesthesia with Inferior Alveolar Nerve Block for Primary Molars.

OBJECTIVES: The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS). STUDY DESIGN: The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests. RESULTS: Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively. CONCLUSIONS: Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.

Mid-Term Dental and Nerve-Related Complications of Infant Distraction for Robin Sequence.

BACKGROUND: Mandibular distraction is effective for relieving airway obstruction in Robin sequence; however, mid-term dental and nerve-related complications have not been adequately studied. METHODS: Records were reviewed for patients with a single distraction in infancy using internal devices. Follow-up was 5 years or longer. Craniofacial dysmorphic syndromes and those affecting facial nerve function were excluded. Part I involved a review of dental records, whereas Part II involved assessment of inferior alveolar and marginal mandibular nerve function in returning patients with the use of 1,1,1,2-tetrafluoroethane cold stimulation and photography, respectively. RESULTS: Eighty-five patients met inclusion criteria. Dental records were complete in 44 patients (median follow-up, 7.3 years; range, 5.4 to 13.2 years). First permanent molar injury was seen in 42 of 88 half-mouths (48 percent); 32 of 42 (76 percent) were restorable. Primary second molar damage and ankylosis were observed in 12 of 88 (14 percent) and one of 88 half-mouths (1 percent), respectively. Mandibular second premolar absence was noted unilaterally in eight of 36 patients (22 percent) and bilaterally in six of 36 patients (17 percent). A mean 1.2 ± 0.95 operative rehabilitations were required. Nerve testing was completed in 20 patients (median follow-up, 8.7 years; range, 5.5 to 13.2 years). Complete absence of cold sensation was noted in one of 40 half-mouths (2.5 percent), whereas lower lip depressor weakness was seen in six of 40 half-mouths (15 percent). CONCLUSIONS: Infant distraction is highly successful in averting tracheostomy; however, dental and nerve-related complications remain underreported. Regular follow-up with a pediatric dentist and early recognition of injury is essential. Although inferior alveolar nerve injury appears infrequent (2.5 percent), permanent lower lip depressor weakness is more common than previously reported (15 percent of sides). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Axonal Degeneration in Dental Pulp Precedes Human Primary Teeth Exfoliation.

The dental pulp in human primary teeth is densely innervated by a plethora of nerve endings at the coronal pulp-dentin interface. This study analyzed how the physiological root resorption (PRR) process affects dental pulp innervation before exfoliation of primary teeth. Forty-four primary canine teeth, classified into 3 defined PRR stages (early, middle, and advanced) were fixed and demineralized. Longitudinal cryosections of each tooth were stained for immunohistochemical and quantitative analysis of dental pulp nerve fibers and associated components with confocal and electron microscopy. During PRR, axonal degeneration was prominent and progressive in a Wallerian-like scheme, comprising nerve fiber bundles and nerve endings within the coronal and root pulp. Neurofilament fragmentation increased significantly during PRR progression and was accompanied by myelin degradation and a progressive loss of myelinated axons. Myelin sheath degradation involved activation of autophagic activity by Schwann cells to remove myelin debris. These cells expressed a sequence of responses comprising dedifferentiation, proliferative activity, GAP-43 overexpression, and Büngner band formation. During the advanced PRR stage, increased immune cell recruitment within the dental pulp and major histocompatibility complex (MHC) class II upregulation by Schwann cells characterized an inflammatory condition associated with the denervation process in preexfoliative primary teeth. The ensuing loss of dental pulp axons is likely to be responsible for the progressive reduction of sensory function of the dental pulp during preexfoliative stages.

Changes in the Distribution of Periodontal Nerve Fibers during Dentition Transition in the Cat.

The periodontal ligament has a rich sensory nerve supply which originates from the trigeminal ganglion and trigeminal mesencephalic nucleus. Although various types of mechanoreceptors have been reported in the periodontal ligament, the Ruffini ending is an essential one. It is unknown whether the distribution of periodontal nerve fibers in deciduous teeth is identical to that in permanent teeth or not. Moreover, morphological changes in the distribution of periodontal nerve fibers during resorption of deciduous teeth and eruption of successional permanent teeth in diphyodont animals have not been reported in detail. Therefore, in this study, we examined changes in the distribution of periodontal nerve fibers in the cat during changes in dentition (i.e., deciduous, mixed and permanent dentition) by immunohistochemistry of protein gene product 9.5. During deciduous dentition, periodontal nerve fibers were concentrated at the apical portion, and sparsely distributed in the periodontal ligament of deciduous molars. During mixed dentition, the periodontal nerve fibers of deciduous molars showed degenerative profiles during resorption. In permanent dentition, the periodontal nerve fibers of permanent premolars, the successors of deciduous molars, increased in number. Similar to permanent premolars, the periodontal nerve fibers of permanent molars, having no predecessors, increased in number, and were densely present in the apical portion. The present results indicate that the distribution of periodontal nerve fibers in deciduous dentition is almost identical to that in permanent dentition although the number of periodontal nerve fibers in deciduous dentition was low. The sparse distribution of periodontal nerve fibers in deciduous dentition agrees with clinical evidence that children are less sensitive to tooth stimulation than adults.

NaV 1.8, but not NaV 1.9, is upregulated in the inflamed dental pulp tissue of human primary teeth.

AIM: To investigate alterations in Na(V) 1.8 and Na(V) 1.9 expression within inflamed dental pulp tissue of human primary teeth. METHODOLOGY: Dental pulp tissue obtained from both normal and inflamed pulps in primary teeth as well as pulps from normal and inflamed permanent teeth was used. The quantity of Na(V) 1.8 and Na(V) 1.9 expression in the dental pulp tissue was investigated using Western blot analysis. General neuron marker (PGP9.5) was used to quantify for neural density, and an increase in metalloproteinase-9 was used to indicate pulpal inflammation in inflamed teeth. Statistically significant differences for each determined parameter between normal and inflamed teeth of both primary and permanent teeth were tested using the Mann-Whitney rank sum test. RESULTS: There was no significant difference in neural density of normal and inflamed dental pulp tissue, although degrees of inflammation were increased in the inflamed dental pulp of both permanent and primary teeth (P < 0.05). Na(V) 1.8 and Na(V) 1.9 expression in inflamed pulps of permanent teeth increased significantly compared with normal permanent teeth (P < 0.05). However, only Na(V) 1.8 expression was increased significantly in the inflamed dental pulp of primary teeth (P < 0.05). CONCLUSIONS: Na(V) 1.8 alone may be the therapeutic target for treatment of painful pulpitis in primary teeth.

Development of innervation in primary incisors in the foetal period.

Sections from the frontal part of the mandible of 43 human foetuses from 9 to 39 weeks of prenatal age, which contained two, three and sometimes four lower incisors were immunohistochemically examined using protein gene product and neuron specific enolase (NSE) antibodies in order to establish the time of appearance of nerve fibres in the developing tooth germ and to define their topography. Nerve fibres were first detected in the dental follicle in the 11th week of intrauterine life. Their presence in the dental papilla was confirmed in the 18th week when the first layers of dentine and enamel were deposited. In the 24th week of intrauterine life, the nerve fibres first reached the subodontoblastic region. In the subsequent weeks, an increase in the number of nerve fibres accompanying blood vessels in the central portion of the dental papilla resulted in the formation of neuro-vascular bundles. Moreover, the progressive deposition of enamel and dentine was accompanied by branching of papillary nerves, which thereby formed a fan-pattern. In the foetal period, no evidence was found for the formation of a subodontoblastic plexus. However, we did observe single nerve fibres in close proximity to the odontoblast layer at the end of intrauterine life. Nerve fibres were not detected in either predentine or dentine throughout foetal life.

Innervation of human tooth pulp in relation to caries and dentition type.

The neural status of carious teeth, particularly those associated with a painful pulpitis, is largely unknown. This study sought to determine differences in the innervation density of human primary and permanent teeth and whether caries or painful pulpitis was associated with anatomical changes in pulpal innervation. Coronal pulps were removed from 120 primary and permanent molars with a known pain history. Teeth were categorized as intact, moderately carious, or grossly carious. Using indirect immunofluorescence, we labeled sections for the general neuronal marker, protein gene product 9.5. Using image analysis, we found permanent teeth to be significantly more densely innervated than primary teeth. While there was no significant correlation with reported pain experience, neural density in both dentitions increased significantly with caries. Analysis of these data suggests that caries-induced changes in neural density may be functionally more important in the regulation of pulpal inflammation and healing than in the processing and perception of dental pain.

On the pulpal nerve supply in primary human teeth: evidence for the innervation of primary dentine.

The presence of nerves in human tooth pulp has been recognized for over a hundred years, and the innervation of dentine for about 40 years. These observations have been made in permanent teeth. Very few studies have reported on the innervation of the primary pulp and dentine. The purpose of this study was to describe the innervation of the primary tooth pulp-dentine complex. Ten mature primary teeth (one incisor, six canines and three molars) were used. Immediately following extraction they were divided into three sections using a diamond disc and saline coolant. They were then immersion fixed in a solution of formaldehyde and picric acid dissolved in a phosphate buffer pH 7.4). The teeth were then demineralized for 1-3 weeks in formic acid. Following complete demineralization, 30 microns sections were cut on a freezing microtome. Neural tissue was stained using a specific antibody to calcitonin gene related peptide (CGRP). Sections were mounted on glass slides and examined using light microscopy. No individual nerve fibres were seen in the control sections, suggesting that the method used was specific for CGRP-containing nerve fibres. The primary teeth appeared to be well innervated. Myelinated and unmyelinated nerves were seen. There was a dense but variable subodontoblastic plexus of nerves (plexus of Raschkow) and nerve fibres were seen to leave this to travel towards the odontoblast layer. Most terminated here, but a few penetrated the odontoblast layer to enter predentine and the dentine tubules. The maximum penetration was 125 microns but most terminated within 30 microns of the dentinopulpal junction. The coronal region was more densely innervated than the root. Within the crown the cervical third was the most densely innervated region, followed by the pulp horn and the middle third. In conclusion, this study has demonstrated that mature primary tooth contains a pulp which is well innervated and has many nerve endings terminating in or near the odontoblast layer, with a small number penetrating into dentine.

Can the location of tooth agenesis and the location of initial bone loss seen in juvenile periodontitis be explained by neural developmental fields in the jaws?

Recent studies on prenatal innervation of the jaws have shown that three separate main innervation paths, constituting three bilateral neural developmental fields (incisor field, canine/premolar field, molar field) exist in each jaw. In this communication the sequences in which the fields are innervated are indicated. These correspond to the sequences of formation of teeth and jawbone. The normal pattern of tooth agenesis is closely related to the neural fields, as the region within a single field were innervation occurs last is always the area most often affected by tooth agenesis. The initial manifestations of juvenile periodontitis also appear at the sites within the different fields where innervation occurs last. It is suggested that the pubertal growth of the alveolar process does not occur in these regions due to deficient innervation, and that the infection in juvenile periodontitis might be secondary to this regional lack of bone apposition.

Immunohistochemical detection of S-100 protein in human deciduous dental pulp.

S-100 protein was investigated in the temporary dental pulp by the immunoperoxidase technique, using the avidin-biotin complex method. The results showed that there was a strong positive reaction in the Schwann cells ensheathing axons and nerve fibers. The other cells within the pulp were immuno-negative. S-100 protein and the results of the present study are discussed.

Patterns and plasticity of dental afferent inputs to trigeminal (V) brainstem neurons in kittens.

In the young cat, the natural replacement of deciduous teeth with a permanent dentition may be accompanied by extensive peripheral nerve degeneration and reinnervation. Since we have previously reported significant physiological effects of tooth pulp deafferentation on V brainstem neurons, we wished to determine if deafferentation associated with deciduous tooth exfoliation was accompanied by comparable neuroplastic changes in the brainstem of kittens. We have examined the pulpal afferent terminating pattern within the brainstem as well as the electrophysiological properties of V brainstem neurons during this naturally occurring deafferentation phenomenon. The pattern of the HRP-labelled terminals in different parts of V brainstem subnuclei in kittens was similar to that in adult cats. The highest density of labelled terminals was found in the subnucleus oralis. The properties of subnucleus oralis neurons also showed many similarities between kittens at age of 3-4 months old and adult cats, e.g., (1) in the proportions of neurons activated by tactile stimulation of 1-4 teeth (mandibular and maxillary canines and premolars), (2) the ratio of neurons showing fast adapting or slow adapting responses to dental tactile stimulation, (3) the proportions of neurons activated by electrical pulp stimulation of 1-4 teeth, and (4) the minimal latencies of pulp-evoked responses. However, the incidences of pulpal inputs as well as the convergent pattern to oralis neurons of afferent inputs evoked by periodontal stimulation and electrical pulpal stimulation were less common in kittens than adult cats.

Nerve growth factor receptor-like immunoreactivity in primary and permanent canine tooth pulps of the cat.

The distribution of nerve growth factor receptor (NGF receptor)-like immunoreactivity in pulps of developing primary and mature permanent cat canine teeth was examined, by use of a monoclonal antibody against NGF receptor detected by fluorescence immunohistochemistry and pre-embedding immunocytochemical light- and electron microscopy. Both primary and permanent pulps contained a vast number of NGF receptor-like immunoreactive nerves. Immunolabelling appeared to be localized both to axons and Schwann cells. In addition, many blood vessel walls in immature primary tooth pulps showed NGF receptor-like immunoreactivity, in contrast to permanent pulps where blood vessels rarely were NGF receptor-immunoreactive. Double-labelling immunofluorescence experiments revealed that in the permanent pulp a majority of the NGF receptor-positive nerves also showed calcitonin gene-related peptide (CGRP)-like immunoreactivity, and many showed substance P-like immunoreactivity. However, nerve fibers with neuropeptide Y-like immunoreactivity lacked NGF receptor-like immunoreactivity. In developing primary tooth pulps fewer NGF receptor-positive nerves were CGRP-like immunoreactive or substance P-like immunoreactive, as compared to the permanent pulp. Neuropeptide Y-like immunoreactive nerve fibers were not detected in the primary tooth pulp. The results suggest a role for nerve growth factor in both developing and mature sensory nerves of the tooth pulp.

Central representation of dental structures in the kitten, including projections to the mesencephalic trigeminal nucleus.

Horseradish peroxidase (HRP) was injected into either a single maxillary or a single mandibular primary (deciduous) cuspid tooth of 8- to 10-week-old kittens. The large apex of the primary cuspid allowed for some leakage of the HRP from the pulpal chamber to the periodontal ligament (PDL). Thus, the injection procedure resulted in the application of HRP to the PDL as well as to the pulpal tissues. The transganglionic transport of HRP resulted in discrete terminal fields within the spinal trigeminal nucleus (STN) and the main sensory nucleus (MSN). These projections were clearly somatotopically organized within the STN, but less so within MSN. Within pars oralis (PO) and pars interpolaris (PI), mandibular cuspid dental structures (MdCDS) were represented in a dorsal position relative to the maxillary cuspid dental structures (MxCDS), whereas within pars caudalis (PC) and the adjacent reticular formation the somatotopic representation was not dorsoventral, but rather mediolateral, with the MdCDS represented more medially than the MxCDS. Areas of overlap between MxCDS and MdCDS were found within MSN and to a lesser degree within the superficial laminae of PC. In addition, the fiber pathway leading to labeled somata in the mesencephalic trigeminal (Mes V) nucleus was clearly identified. The majority of the fibers traced to the Mes V nucleus exited the spinal trigeminal tract at the level of the transition from PO to the MSN and traversed the nuclear region in a position dorsal to and separate from the trigeminal motor tract. As in STN, fibers within the caudal Mes V tract appeared to be somatotopically organized, with the fibers from the MdCDS generally more dorsal than the ones from the MxCDS. Labeled fibers, some with terminal arbors, were also identified in close association with the trigeminal motor tract. The findings show a complex pattern of central representation in the immature feline central nervous system for deciduous dental structures.

[Development of dental tissues innervation in primary teeth. Experimental study on dogs]. / Melete tes anaptyxes enneuroses ton odontikon ioton sta neogila. Peiramatike ereuna se skylous.

In this work it was studied the innervation of pulp-dentin in primary premolars on experimental - dogs of 15, 35, 55 days old, with the aid of stainings Alcian blue/PAS and Bielschowsky. On 15 days old experimental dogs there were seen nerve fibres subodontoblastically. On 35 days old experimental dogs nerve fibres were directed towards the odontoblasts, there were also seen neural loops subodontoblastically and terminal nerve fibres on the exterior surface of the vessels. On 55 days old experimental dogs there was seen a great number of argyrophilic fibres in the district of the relapse of the dentine and pulp.

Innervation of the dental pulp during tooth succession in the cat.

The possibility that axons branch to supply the pulps of both the upper deciduous canine tooth and its permanent successor has been investigated by stimulating the pulp of one tooth and recording from the pulp of the other. In cats less than about 14 weeks of age, the permanent canine was too poorly developed to allow electrodes to be applied to it satisfactorily. In 5 of 14 preparations in cats aged 14-23 weeks, compound action potentials were recorded in one canine during stimulation of the other. These responses were not abolished by sectioning the infraorbital nerve or its canine branch in the floor of the orbit or by paralysing the animal, but they were abolished by sectioning the pulp of the permanent canine, indicating that they were due to branched axons. In preparations in which there was no tooth-to-tooth response, there was usually evidence that the pulp of one or other of the teeth did not have a functional innervation. The results indicate that at least some of the nerves which supply the pulp of a deciduous tooth are retained to supply its permanent successor.

Representation of upper and lower primary teeth in the trigeminal sensory nuclear complex in the young dog.

Transganglionic transport of horseradish peroxidase-wheat germ agglutinin conjugate entrapped in polyacrylamide gel was used to study the patterns of termination of primary afferents that innervate the upper and lower primary tooth pulps within the trigeminal sensory nuclear complex of the young dog. The lower and upper primary tooth pulp afferents projected to the subnucleus dorsalis of the principal nucleus, the rostrodorsomedial part and subnucleus dorsomedialis (Vo.dm) of the pars oralis, the nucleus of the intermediate plexus (Vi.ip) of the pars interpolaris, and laminae I, II and V of the caudalis. The lower and upper primary teeth were topographically represented in the Vo.dm, rostrocaudal mid-levels of Vi.ip, and in laminae I/V of the caudal levels of the pars caudalis, whereas an extensive overlapped projection was seen in other subdivisions.

Innervation of teeth: qualitative, quantitative, and developmental assessment.

Anatomical characteristics of tooth innervation provide insights into functional capabilities as well as limitations of this organ. In this review, innervation will be discussed from two major viewpoints. The first part will present distribution of nerve fibers in the tooth; nerve pathways, both autonomic and sensory, will be discussed mostly from a descriptive standpoint. In the second part, quantitation of neural units along key points of the pathways will be presented at milestones in tooth and organism development and aging.