Topical review. Dental pain and odontoblasts: facts and hypotheses.
Topical review. Dental pain and odontoblasts: facts and hypotheses.
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发表时间：
2010
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通讯作者：
H. Magloire;J. Maurin;M. Couble;Y. Shibukawa;Maki Tsumura;B. Thivichon-Prince;F. Bleicher
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作者：
H. Magloire;J. Maurin;M. Couble;Y. Shibukawa;Maki Tsumura;B. Thivichon-Prince;F. Bleicher
牙痛是由于牙釉质细菌、化学或机械侵蚀和/或牙龈退缩后暴露的牙本质引起的。因此，牙本质组织，更具体地说，牙本质小管是与牙本质敏感有关的第一个结构。有趣的是，牙本质的结构可以通过成牙本质细胞(牙本质形成细胞)，通过它们的根尖延伸沐浴在小管中的牙本质液中，或者通过与成牙本质细胞密切相关的三叉神经感觉轴突的密集网络，将信息传递到潜在的牙髓。因此，引起牙本质液运动、成牙本质细胞和/或神经复合体反应的外部刺激可能代表着一种独特的机械感觉系统，为成牙本质细胞作为传感细胞带来了新的作用。细胞如何感知信号以及后者如何传递到轴突是有待解决的主要问题。然而，一些证据表明，成牙本质细胞表达机械和/或温度敏感的瞬时感受器电位离子通道(TRPV1、TRPV2、TRPV3、TRPV4、TRPM3、KCA、TREK-1)，这些通道可能感受热和/或冷或牙本质液在小管内的运动。此外，电压门控钠通道在体外赋予成牙本质细胞对注入去极化电流的兴奋特性。在体内，钠通道与神经末梢共同定位在成牙本质细胞的顶端，并与牵张激活的KCA通道的空间分布相关。这突出了末端网是牙髓/牙本质复合体感知外部刺激的关键区域。鉴于三叉神经传入纤维上存在伤害性感受受体的证据以及成牙本质细胞表达可能的效应因子，成牙本质细胞和轴突之间的串扰可能是通过在成牙本质细胞和轴突之间的间隙释放介质而发生的。最后，本文对轴突如何被引导到靶细胞以及涉及哪些信号分子进行了广泛的讨论。
Dental pain arises from exposed dentin following bacterial, chemical, or mechanical erosion of enamel and/or recession of gingiva. Thus, dentin tissue and more specifically patent dentinal tubules represent the first structure involved in dentin sensitivity. Interestingly, the architecture of dentin could allow for the transfer of information to the underlying dental pulp via odontoblasts (dentin-forming cells), via their apical extension bathed in the dentinal fluid running in the tubules, or via a dense network of trigeminal sensory axons intimately related to odontoblasts. Therefore, external stimuli causing dentinal fluid movements and odontoblasts and/or nerve complex responses may represent a unique mechanosensory system bringing a new role for odontoblasts as sensor cells. How cells sense signals and how the latter are transmitted to axons represent the main questions to be resolved. However, several lines of evidence have demonstrated that odontoblasts express mechano- and/or thermosensitive transient receptor potential ion channels (TRPV1, TRPV2, TRPV3, TRPV4, TRPM3, KCa, TREK-1) that are likely to sense heat and/or cold or movements of dentinal fluid within tubules. Added to this, voltage-gated sodium channels confer excitable properties of odontoblasts in vitro in response to injection of depolarizing currents. In vivo, sodium channels co-localize with nerve terminals at the apical pole of odontoblasts and correlate with the spatial distribution of stretch-activated KCa channels. This highlights the terminal web as the pivotal zone of the pulp/dentin complex for sensing external stimuli. Crosstalk between odontoblasts and axons may take place by the release of mediators in the gap space between odontoblasts and axons in view of evidence for nociception-transducing receptors on trigeminal afferent fibers and expression of putative effectors by odontoblasts. Finally, how axons are guided to the target cells and which kind of signaling molecules are involved is extensively discussed in this review.