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Feasibility and reliability of intraorally evoked “nociceptive-specific” blink reflexes

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Abstract

Objectives

The “nociceptive-specific” blink reflex (nBR) evoked by extraoral stimulation has been used to assess trigeminal nociceptive processing in patients with trigeminal nerve damage regardless of the site of damage. This study aimed to test the feasibility of nBR elicited by intraoral stimulation, compare intraoral and extraoral nBR and assess the intrarater and interrater reliability of the intraoral nBR for the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve.

Materials and methods

In 17 healthy participants, nBR was elicited by stimulation of two extraoral and two intraoral sites by two operators and repeated intraorally by one operator. Main outcome variables were intraoral stimulus-evoked pain scores and nBR R2 responses at different stimulus intensities. Intraclass correlation coefficients (ICC) were used to assess reliability.

Results

Dependent on the stimulus intensity, intraoral stimulation evoked R2 responses in up to 12/17 (70.6%) participants for V2 and up to 8/17 (47.1%) participants for V3. Pain scores (p < 0.003) and R2 responses (p < 0.004) increased with increasing intensities for V2, but not V3. The R2 responses were significantly smaller with intraoral stimulation compared to extraoral stimulation (p < 0.014). Overall, ICCs were fair to excellent for V2 but poor for V3.

Conclusion

Intraorally evoked nBR was feasible in a subset of healthy participants and was less responsive than nBR with extraoral stimulation. The V2 nBR showed better reliability than V3.

Clinical relevance

The nBR can be used to assess nerve damage to the maxillary intraoral regions, though other measures may need to be considered for the mandibular intraoral regions.

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Funding

This study was funded by the Danish Dental Association.

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Authors and Affiliations

  1. Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark

    Rajath Sasidharan Pillai, Peter Svensson & Lene Baad-Hansen

  2. Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark

    Rajath Sasidharan Pillai, Maria Pigg, Thomas List, Peter Svensson & Lene Baad-Hansen

  3. Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden

    Rajath Sasidharan Pillai, Maria Pigg, Thomas List, Peter Svensson & Lene Baad-Hansen

  4. Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Cung May Thai, Laura Zweers, Michail Koutris & Frank Lobbezoo

  5. Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil

    Yuri Martins Costa

  6. Department of Endodontics, Faculty of Odontology, Malmӧ University, Malmӧ, Sweden

    Maria Pigg

  7. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmӧ University, Malmӧ, Sweden

    Thomas List

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  1. Rajath Sasidharan Pillai
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  2. Cung May Thai
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  3. Laura Zweers
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  10. Lene Baad-Hansen
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Correspondence to Rajath Sasidharan Pillai.

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Pillai, R.S., Thai, C.M., Zweers, L. et al. Feasibility and reliability of intraorally evoked “nociceptive-specific” blink reflexes. Clin Oral Invest 24, 883–896 (2020). https://doi.org/10.1007/s00784-019-02966-1

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