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

我们试图分析牙髓炎和/或根尖周病患者头面部的生理变化，并比较牙髓治疗前后的数据。然而，很难得到抱怨剧烈疼痛的患者的合作。我们认为对患有牙髓疾病的疼痛患者进行生理检查是必要的，但获得他们的知情同意仍然是困难的情况。“芥子油：钼”作为化学条件刺激应用于牙髓，引起周围和中枢神经系统的神经生理和神经药理反应特性的改变。在理论面区具有感受野的延髓背角(VC)或脑干网状结构(RF)中的牙髓驱动神经元的反应性表现出不同的高兴奋模式。特别是，在MO条件性刺激后，RF牙髓驱动神经元的反应性显著增加，全身应用纳洛酮对其反应性有显著的复燃作用。VC牙髓驱动神经元与RF驱动神经元之间的反应性变化有统计学意义。这些神经元反应性的改变可能与使用MO牙髓后反射诱发的颌肌肌电活动增加密切相关。在应用芥子油的牙髓中，既有传入纤维的过度兴奋，也有邻牙和MO牙髓中血流量的增加。这些现象可能是由支配多个牙髓的分支传入神经的轴突反射引起的，提示单颗牙的牙髓炎有可能引起多颗牙的临床症状。

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.