RESUMO
BACKGROUND: Tumor necrosis factor alpha (TNFα) is increased in patients with headache, neuropathic pain, periodontal and temporomandibular disease. This study and others have utilized TNF receptor 1/2 (TNFR1/2) knockout (KO) animals to investigate the effect of TNFα dysregulation in generation and maintenance of chronic neuropathic pain. The present study determined the impact of TNFα dysregulation in a trigeminal inflammatory compression (TIC) nerve injury model comparing wild-type (WT) and TNFR1/2 KO mice. METHODS: Chromic gut suture was inserted adjacent to the infraorbital nerve to induce the TIC model mechanical hypersensitivity. Cytokine proteome profiles demonstrated serology, and morphology explored microglial activation in trigeminal nucleus 10weeks post. RESULTS: TIC injury induced ipsilateral whisker pad mechanical allodynia persisting throughout the 10-week study in both TNFR1/2 KO and WT mice. Delayed mechanical allodynia developed on the contralateral whisker pad in TNFR1/2 KO mice but not in WT mice. Proteomic profiling 10weeks after chronic TIC injury revealed TNFα, interleukin-1alpha (IL-1α), interleukin-5 (IL-5), interleukin-23 (IL-23), macrophage inflammatory protein-1ß (MIP-1ß), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were increased more than 2-fold in TNFR1/2 KO mice compared to WT mice with TIC. Bilateral microglial activation in spinal trigeminal nucleus was detected only in TNFR1/2 KO mice. p38 mitogen-activated protein kinase (MAPK) inhibitor and microglial inhibitor minocycline reduced hypersensitivity. CONCLUSIONS: The results suggest the dysregulated serum cytokine proteome profile and bilateral spinal trigeminal nucleus microglial activation are contributory to the bilateral mechanical hypersensitization in this chronic trigeminal neuropathic pain model in the mice with TNFα dysregulation. Data support involvement of both neurogenic and humoral influences in chronic neuropathic pain.
Assuntos
Citocinas/metabolismo , Dor Facial/fisiopatologia , Hiperalgesia/fisiopatologia , Proteoma/metabolismo , Traumatismos do Nervo Trigêmeo/fisiopatologia , Fator de Necrose Tumoral alfa/metabolismo , Animais , Modelos Animais de Doenças , Dor Facial/tratamento farmacológico , Dor Facial/patologia , Temperatura Alta , Hiperalgesia/tratamento farmacológico , Hiperalgesia/patologia , Masculino , Camundongos da Linhagem 129 , Camundongos Transgênicos , Microglia/efeitos dos fármacos , Microglia/patologia , Microglia/fisiologia , Receptores Tipo I de Fatores de Necrose Tumoral/genética , Receptores Tipo I de Fatores de Necrose Tumoral/metabolismo , Receptores Tipo II do Fator de Necrose Tumoral/genética , Receptores Tipo II do Fator de Necrose Tumoral/metabolismo , Tato , Traumatismos do Nervo Trigêmeo/tratamento farmacológico , Traumatismos do Nervo Trigêmeo/patologiaRESUMO
This article focuses on the elderly patient and developmentally disabled children and adults. Although many individuals in these groups can receive dental care with only the use of local anesthetic, this article focuses on those that require sedation or general anesthesia. Areas in which the management of these patients significantly differs from routine anesthesia are emphasized.
Assuntos
Anestesia Dentária , Assistência Odontológica para Idosos , Assistência Odontológica para Doentes Crônicos , Assistência Odontológica para a Pessoa com Deficiência , Adulto , Idoso , Obstrução das Vias Respiratórias/prevenção & controle , Pré-Escolar , Sedação Consciente/métodos , Assistência Odontológica para Crianças , Testes Diagnósticos de Rotina , Humanos , Lactente , Medicação Pré-AnestésicaRESUMO
When fear of dental treatment is so extreme as to make the options commonly available to the general dentist (such as nitrous oxide, oral medication and psychosedation) inadequate, general anesthesia may be required. Protocol for treating patients under general anesthesia are presented, as well as two cases of such treatment.