Clinical psychologic analysis for the pain in patients suffering from pulpal pathosis and responsiveness changes in the tooth pulp-driven neurons in the central nervous system

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This study was aimed to elucidate the physiological mechanisms of pain observed in the patients with dental pulp pathosis. We have tried to perform the combined study of the clinical psychological analysis for the pain in patients suffering from pulpal pathosis and the basic neurophysiological investigation for the responsiveness changes in tooth pulp-driven neurons.Using the Japanese McGill Pain Questionnaire, the pain description terms were examined in patients suffering from the broad pulpal pathosis. The pain intensity was detected by the visual analog scale (VAS) method. It was difficult to generalize the pain terms specific with pulpitis because of the absence of the cases. It was demonstrated that there were some differences describing the pain caused by the acute and the chronic conditions. Especially, the patients with acute inflammation frequently selected the terms in affective subclass and evaluative subclass. There was no significant differences of the VAS values between i … More n the acute phase patients and in the chronic, eventhough the mean VAS value of the former was larger than the one of the latter.The neurophysiologic investigation for responsiveness changes in the tooth pulp-driven neurons in the central nervous system (CNS) revealed that different types of central sensitization were elicited in neurons in the trigeminal spinal cord nucleus (subnucleus caudalis ), brain stem reticular formation, or ventral posteromedial thalamic nucleus. These nuclei contain relay neurons which transfer the trigeminal information including the pulp one projecting to the higher brain area, and have close relations in processing the sensory-descriminative aspects of pain and the emotional-affective aspects. These neurons would modify their responsiveness with the ascending oan/or descending control system in the brain. These results suggest that the central sensitization phenomena or some neuroplastic changes have occurred in the CNS in patients suffering from severe pain of tooth origin. Less