Clinical examination of thecranio-facial pain associated with tooth pulppathosis and the neuronal hyperresponsiveness observed in animal with experimentally induced pulpitis

我们试图分析患有牙髓炎和/或根周病变的患者颅面区域的生理变化，并比较根管治疗前后的数据记录。然而，很难得到那些抱怨剧痛的病人的配合。我们认为对患牙髓炎的疼痛患者进行生理检查是必要的，但很难得到患者的知情同意。将“芥菜油：MO”应用于牙髓作为一种化学调理刺激，产生了外周和中枢神经系统神经生理和神经药理反应特性的改变。在颅面区有感受野的髓质背角（Vc）和脑干网状结构（RF）中，牙髓驱动神经元的反应表现出不同的超兴奋模式。特别是，在MO条件刺激后，观察到RF牙髓驱动神经元的反应性随着时间的流逝而显著增加，并且全身给药纳洛酮对其反应性产生了显著的再点燃作用。Vc牙髓驱动神经元与RF牙髓驱动神经元的反应性变化有统计学意义。这些神经元反应性变化可能与MO牙髓应用后反射性颌肌肌电活动的增加密切相关。将芥菜油涂在牙髓上，不仅会引起邻近牙齿牙髓的传入纤维亢进，而且会增加所涂牙齿牙髓的血流量。这些现象可能是由支配多牙髓的分支传入神经的轴突反射引起的，提示单牙髓炎有可能诱发多牙临床症状。

We have tried to analyze the physiological changes of thcranio-facial regionsin patients suffering from thepulpitis and/or periradicular pathosis, and to compare the data recorded in the periods of before and afterendodontic treatment. It was, however, difficult to getcooperations of patients who were complaining of severe pain. We thought that it was necessary to perform the physiological examination of the patients with pain suffering frompulpal diseases, but it remained difficult situations of getting theinformed-consent for the examination from them.The application of "mustard oil : MO" to the tooth pulp as a chemical conditioning stimulation produced the alterations of the neurophysilogical and neuropharmacological response prccperties in the peripheral and central nervous system. Respccnsiveness of the tooth pulp-driven neurons in themedullary dorsal horn (Vc) or brain stem reticular formation (RF), which had the receptive field in theoro-facial region, showed different pattern of hyper excitation. Especially, a significant increase in the responsiveness of the RF tooth pulp-driven neuron was observed with elapse after MO conditioning stimulation, and systemic administration of naloxone produced a significant rekindling effect in its responsiveness. A statistical significance was found in the responsiveness changes between the Vc tooth pulp-driven neuron and the RF one. These neuronal responsiveness changes may be closely related to the increase of reflex-induced jaw muscle EMG activities by MO tooth pulp application.Mustard oil application to a tooth pulp produced both hyperexcitation of the afferent fibers and increase of the blood flow in the pulp of neighboring teeth as well as in the MO applied one. These phenomena may be caused by the axon reflex of the branched afferents innervating the plural teeth pulp, which suggests that thepulpal inflammation in a single tooth has a possibility of inducing the clinical symptoms in the plural teeth.