Skip to main content

Dental Pain, Mechanism of Action

  • Chapter
  • First Online:
Contemporary Endodontics for Children and Adolescents

Abstract

The term dental pain refers to dentinal pain associated with sensory activation of the dentine as a result of caries lesion or trauma and pulpal pain associated usually with inflammatory reaction of the pulp tissue. The mechanism of pain generation and transfer is complex and in interactions with the central mechanism of pain and sensation. This chapter focuses on the suspected mechanisms involved in dental pain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–82.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Liu XX, Tenenbaum HC, Wilder RS, Quock R, Hewlett ER, Ren YF. Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners. BMC Oral Health. 2020;20(1):220.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Anderson DJ, Hannam AG, Mathews B. Sensory mechanisms in mammalian teeth and their supporting structures. Physiol Rev. 1970;50(2):171–95.

    Article  PubMed  Google Scholar 

  4. Brannstrom M. The elicitation of pain in human dentine and pulp by chemical stimuli. Arch Oral Biol. 1962;7:59–62.

    Article  PubMed  Google Scholar 

  5. Byers MR, Narhi MV. Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions. Crit Rev Oral Biol Med. 1999;10(1):4–39.

    Article  PubMed  Google Scholar 

  6. Olgart LM. The role of local factors in dentin and pulp in intradental pain mechanisms. J Dent Res. 1985;64:572–8.

    Article  PubMed  Google Scholar 

  7. Magloire H, Maurin JC, Couble ML, Shibukawa Y, Tsumura M, Thivichon-Prince B, et al. Topical review. Dental pain and odontoblasts: facts and hypotheses. J Orofac Pain. 2010;24(4):335–49. Epub 2011/01/05

    PubMed  Google Scholar 

  8. Chung G, Jung SJ, Oh SB. Cellular and molecular mechanisms of dental nociception. J Dent Res. 2013;92(11):948–55. Epub 2013/08/21

    Article  PubMed  Google Scholar 

  9. Aminoshariae A, Kulild JC. Current concepts of dentinal hypersensitivity. J Endod. 2021;47(11):1696–702.

    Article  PubMed  Google Scholar 

  10. Byers MR, Kish SJ. Delineation of somatic nerve endings in rat teeth by radioautography of axon-transported protein. J Dent Res. 1976;55(3):419–25.

    Article  PubMed  Google Scholar 

  11. Byers MR, Neuhaus SJ, Gehrig JD. Dental sensory receptor structure in human teeth. Pain. 1982;13(3):221–35.

    Article  PubMed  Google Scholar 

  12. Okumura R, Shima K, Muramatsu T, Nakagawa K, Shimono M, Suzuki T, et al. The odontoblast as a sensory receptor cell? The expression of TRPV1 (VR-1) channels. Arch Histol Cytol. 2005;68(4):251–7.

    Article  PubMed  Google Scholar 

  13. Ushiyama J. Gap junctions between odontoblasts revealed by transjunctional flux of fluorescent tracers. Cell Tissue Res. 1989;258(3):611–6.

    Article  PubMed  Google Scholar 

  14. Matthews B, Sessle BJ. Peripheral mechanisms of orofacial pain. In: Lund JPLG, Dubner R, Sessle BJ, editors. Orofacial pain from basic science to clinical management. Chicago: Quintessence; 2000. p. 37–46.

    Google Scholar 

  15. Armstrong D, Dry RM, Keele CA, Markham JW. Observations on chemical excitants of cutaneous pain in man. J Physiol. 1953;120(3):326–51.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anderson DJ, Naylor MN. Chemical excitants of pain in human dentine and dental pulp. Arch Oral Biol. 1962;7:413–5.

    Article  PubMed  Google Scholar 

  17. Brannstrom M. Dentin sensitivity and aspiration of odontoblasts. J Am Dent Assoc. 1963;66:366–70.

    Article  PubMed  Google Scholar 

  18. Narhi M, Jyvasjarvi E, Virtanen A, Huopaniemi T, Ngassapa D, Hirvonen T. Role of intradental A- and C-type nerve fibres in dental pain mechanisms. Proc Finn Dent Soc. 1992;88(suppl 1):507–16.

    PubMed  Google Scholar 

  19. Lee K, Lee BM, Park CK, Kim YH, Chung G. Ion channels involved in tooth pain. Int J Mol Sci. 2019;20:2266. Epub 2019/05/11

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hossain MZ, Bakri MM, Yahya F, Ando H, Unno S, Kitagawa J. The role of transient receptor potential (TRP) channels in the transduction of dental pain. Int J Mol Sci. 2019;20(3):526.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fried K, Sessle BJ, Devor M. The paradox of pain from tooth pulp: low-threshold "algoneurons"? Pain. 2011;152(12):2685–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pigg M, Nixdorf DR, Law AS, Renton T, Sharav Y, Baad-Hansen L, et al. New international classification of orofacial pain: what is in it for endodontists? J Endod. 2021;47(3):345–57.

    Article  PubMed  Google Scholar 

  23. Byers MR, Narhi MVO. Nerve supply of the pulpodentin complex and response to injury. In: Hargreaves KM, Goodies HE, editors. Seltzer and Bender’s dental pulp. Chicago: Quintessence; 2002. p. 151–79.

    Google Scholar 

  24. Hargreaves KM, Seltzer S. Pharmacologic control of dental pain. In: Hargreaves KM, Goodies HE, editors. Seltzer and Bender’s dental pulp. Chicago: Quintessence; 2002. p. 205–25.

    Google Scholar 

  25. Goodis HE, Bowles WR, Hargreaves KM. Prostaglandin E2 enhances bradykinin-evoked iCGRP release in bovine dental pulp. J Dent Res. 2000;79(8):1604–7.

    Article  PubMed  Google Scholar 

  26. Lee PR, Lee JH, Park JM, Oh SB. Upregulation of toll-like receptor 2 in dental primary afferents following pulp injury. Exp Neurobiol. 2021;30(5):329–40.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol. 2013;75:365–91.

    Article  PubMed  Google Scholar 

  28. Rodd HD, Boissonade FM. Comparative immunohistochemical analysis of the peptidergic innervation of human primary and permanent tooth pulp. Arch Oral Biol. 2002;47(5):375–85.

    Article  PubMed  Google Scholar 

  29. Itoh K. The distribution of nerves in human deciduous and permanent teeth. Arch Histol Jpn. 1976;39(5):379–99.

    Article  PubMed  Google Scholar 

  30. Benoliel R, Elishoov H, Sharav Y. Orofacial pain with vascular-type features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(5):506–12.

    Article  PubMed  Google Scholar 

  31. Penarrocha M, Bandres A, Penarrocha M, Bagan JV. Lower-half facial migraine: a report of 11 cases. J Oral Maxillofac Surg. 2004;62(12):1453–6.

    Article  PubMed  Google Scholar 

  32. Rodd HD, Boissonade FM. Substance P expression in human tooth pulp in relation to caries and pain experience. Eur J Oral Sci. 2000;108(6):467–74.

    Article  PubMed  Google Scholar 

  33. Hughes SR, Williams TJ, Brain SD. Evidence that endogenous nitric oxide modulates oedema formation induced by substance P. Eur J Pharmacol. 1990;191(3):481–4.

    Article  PubMed  Google Scholar 

  34. Lundy FT, Linden GJ. Neuropeptides and neurogenic mechanisms in oral and periodontal inflammation. Crit Rev Oral Biol Med. 2004;15(2):82–98.

    Article  PubMed  Google Scholar 

  35. Awawdeh LA, Lundy FT, Linden GJ, Shaw C, Kennedy JG, Lamey PJ. Quantitative analysis of substance P, neurokinin a and calcitonin gene-related peptide in gingival crevicular fluid associated with painful human teeth. Eur J Oral Sci. 2002;110(3):185–91.

    Article  PubMed  Google Scholar 

  36. Trowbridge H, Kim S. Pulp development structure and function. In: Cohen S, Burnse RC, editors. Pathways of the pulp. 7th ed. St Louis: CV Mosby; 1996.

    Google Scholar 

  37. Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP. Antigenicity of primary endodontic infection against macrophages by the levels of PGE(2) production. J Endod. 2011;37(5):602–7. Epub 20110305

    Article  PubMed  Google Scholar 

  38. Kokkas AB, Goulas A, Varsamidis K, Mirtsou V, Tziafas D. Irreversible but not reversible pulpitis is associated with up-regulation of tumour necrosis factor-alpha gene expression in human pulp. Int Endod J. 2007;40(3):198–203.

    Article  PubMed  Google Scholar 

  39. Bae YC, Yoshida A. Morphological foundations of pain processing in dental pulp. J Oral Sci. 2020;62(2):126–30.

    Article  PubMed  Google Scholar 

  40. Madison S, Whitsel EA, Suarez-Roca H, Maixner W. Sensitizing effects of leukotriene B4 on intradental primary afferents. Pain. 1992;49(1):99–104.

    Article  PubMed  Google Scholar 

  41. Sessle BJ, Bradley RM, Dubner R, Matthews B, Moller E. Dental neuroscience. New Dent. 1979;10(4):32–8.

    PubMed  Google Scholar 

  42. McGrath PA, Gracely RH, Dubner R, Heft MW. Non-pain and pain sensations evoked by tooth pulp stimulation. Pain. 1983;15(4):377–88.

    Article  PubMed  Google Scholar 

  43. Brown AC, Beeler WJ, Kloka AC, Fields RW. Spatial summation of pre-pain and pain in human teeth. Pain. 1985;21(1):1–16.

    Article  PubMed  Google Scholar 

  44. Virtanen AS, Huopaniemi T, Narhi MV, Pertovaara A, Wallgren K. The effect of temporal parameters on subjective sensations evoked by electrical tooth stimulation. Pain. 1987;30(3):361–71.

    Article  PubMed  Google Scholar 

  45. Tal M, Sharav Y. Development of sensory and reflex responses to tooth-pulp stimulation in children. Arch Oral Biol. 1985;30(6):467–70.

    Article  PubMed  Google Scholar 

  46. Avery JK. Structural elements of the young normal human pulp. Oral Surg Oral Med Oral Pathol. 1971;32(1):113–25.

    Article  PubMed  Google Scholar 

  47. Hu JW, Sharav Y, Sessle BJ. Effects of one- or two-stage deafferentation of mandibular and maxillary tooth pulps on the functional properties of trigeminal brainstem neurons. Brain Res. 1990;516(2):271–9.

    Article  PubMed  Google Scholar 

  48. Chiang CY, Park SJ, Kwan CL, Hu JW, Sessle BJ. NMDA receptor mechanisms contribute to neuroplasticity induced in caudalis nociceptive neurons by tooth pulp stimulation. J Neurophysiol. 1998;80(5):2621–31.

    Article  PubMed  Google Scholar 

  49. Chattipakorn SC, Sigurdsson A, Light AR, Narhi M, Maixner W. Trigeminal c-Fos expression and behavioral responses to pulpal inflammation in ferrets. Pain. 2002;99(1–2):61–9.

    Article  PubMed  Google Scholar 

  50. Sessle BJ. Peripheral and central mechanisms of orofacial pain and their clinical correlates. Minerva Anestesiol. 2005;71(4):117–36.

    PubMed  Google Scholar 

  51. Kobayashi M, Nakaya Y. Anatomical aspects of corticotrigeminal projections to the medullary dorsal horn. J Oral Sci. 2020;62(2):144–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yaron Haviv .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Haviv, Y., Leibovitz, S., Sharav, Y. (2023). Dental Pain, Mechanism of Action. In: Fuks, A.B., Moskovitz, M., Tickotsky, N. (eds) Contemporary Endodontics for Children and Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-031-23980-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-23980-9_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-23979-3

  • Online ISBN: 978-3-031-23980-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics