Journal of Pain Research (Dec 2017)
Dental pain induced by an ambient thermal differential: pathophysiological hypothesis
Abstract
Anaïs Le Fur-Bonnabesse,1,2 Céline Bodéré,1–3 Cyrielle Hélou,2 Valérie Chevalier,2,4 Jean-Paul Goulet5 1Laboratory of Neurosciences of Brest (EA4685), University of Western Brittany, Brest, France; 2Dental School, University of Western Brittany, Brest, France; 3Assessment and Treatment Center of Pain, Regional and University Hospital Center, Brest, France; 4Laboratory IRDL, FRE CNRS 3744, University of Western Brittany, Brest, France; 5School of Dental Medicine, Universite Laval, Quebec, QC, Canada Abstract: Dental pain triggered by temperature differential is a misrecognized condition and a form of dental allodynia. Dental allodynia is characterized by recurrent episodes of diffuse, dull and throbbing tooth pain that develops when returning to an indoor room temperature after being exposed for a long period to cold weather. The pain episode may last up to few hours before subsiding. Effective treatment is to properly shield the pulpal tissue of the offending tooth by increasing the protective layer of the dentin/enamel complex. This review underscores the difference in dentin hypersensitivity and offers a mechanistic hypothesis based on the following processes. Repeated exposure to significant positive temperature gradients (from cold to warm) generates phenotypic changes of dental primary afferents on selected teeth with subsequent development of a “low-grade” neurogenic inflammation. As a result, nociceptive C-fibers become sensitized and responsive to innocuous temperature gradients because the activation threshold of specific TRP ion channels is lowered and central sensitization takes place. Comprehensive overviews that cover dental innervation and sensory modalities, thermodynamics of tooth structure, mechanisms of dental nociception and the thermal pain are also provided. Keywords: pain, dental pain, thermal allodynia, atypical tooth sensitivity, dentin hypersensitivity
