Neural substrates of the oro-facial pain

Oro-facial sensory innervations.

Sensory perception in oro-facial district

Mechanosensatio
n Thermal
sensation
Sensory perception in oro-facial district

SOMATIC SENSITIVITY

TRIGEMINAL DIVISION SPINAL DIVISION

1. RELAIS STATIONS ARE DIFFERENT IN THE TWO DIVSIONS

TRIGEMINAL NERVE BRAIN STEM
SPINAL DIVISION DORSAL HORN-POSTERIOR COLUMN NUCLEI

2. INPUTS FROM TRIGEMIAL DIVISION USED TO CONTROL MASTICATION-

SWOLLOWING-FONATORY FUNCTION

3. IN ANIMALS IMPORTANT EXPLORATORY FUNCTION VERY SIMILAR TO HAND

EXPLORATORY FUNCTION IN HUMANS
Sensory perception in oro-facial district

SENSORY INNERVATION: TRIGEMINAL NERVE

Dermatomes of Head and Neck

rr/%
e CIBI'I GEIGY
Sensory perception in oro-facial district

SENSORY INNERVATION: TRIGEMINAL NERVE...AND THE OTHERS

OPHTALMIC BRANCH
SENSORY INFORMATION FROM SCALP AND FOREHEAD,
UPPER EYELID, CONJUNCTIVA AND CORNEA OF THE
EYE, NOSE (INCLUDING THE TIP, EXCEPT ALAE NASI),
NASAL MUCOSA, FRONTAL SINUSES, AND PARTS OF
THE MENINGES (THE DURA AND BLOOD VESSELS).

MAXILLARY BRANCH
SENSORY INFORMATION FROM THE LOWER EYELID
AND CHEEK, THE NARES AND UPPER LIP, THE UPPER
TEETH AND GUMS, THE NASAL MUCOSA, THE PALATE
AND ROOF OF THE PHARYNX, THE MAXILLARY,
ETHMOID AND SPHENOID SINUSES, AND PARTS OF THE
MENINGES.

MANDIBOLAR BRANCH
SENSORY INFORMATION FROM THE LOWER LIP, THE
LOWER TEETH AND GUMS, THE CHIN AND JAW
(EXCEPT THE ANGLE OF THE JAW, WHICH IS SUPPLIED
BY C2-C3), PARTS OF THE EXTERNAL EAR, AND PARTS
OF THE MENINGES. THE MANDIBULAR NERVE CARRIES
TOUCH/POSITION AND PAIN/TEMPERATURE SENSATION
FROM THE MOUTH.

ALL FIBERS FORM GASSERS SEMILUNAR GANGLION WITH THE EXCEPTION OF :

1. MUSCLE SPINDLES AFFERENT FIBERS AND MECHANORECEPTORSOF PERIODONTAL LIGAMENT (MESENCEPHALIC
TRIGEMINAL NUCLEUS)
2. FIBERS FROM PINNAS LATERAL SURFACE (FACIAL NERVE, VII)
3. SOFT PALATE- ISTHMUS OF FAUCES-PHARYNX POSTERIOR 1/3 TONGUE,-MIDDLE EAR, EUSTACHIAN TUBE (GLOSSO-FARINGEAL
NERVE, IX)
4. PINNAS MEDIAL SURFACE- EAR CANAL (VAGAL NERVE, X)

ALL FIBERS END UP IN THE SPINAL PORTION OF TRIGEMINAL NUCLEUS

Sensory perception in oro-facial districi

SENSORY INNERVATION: TRIGEMINAL NERVE ...AND THE OTHERS

zygomaticofacial
pregang. i l
CNVII

\ r. petrosal

POS. SUP.

PHARYNGEAV f \ NASAl

= : T I N R PA HNE

tTllcosa o f 1'\aro
e.tld soft pat5 es

BUCCAL
ch & v ngMJ
{ IIOT motor for bucaletor m )

postgang. to submandbubr & subk'lgual g n d

ant 213tonqu-e. Rx>r of rnouth. gn gm 1

taste trom ant m tongue

motor to tn")'bhyoi:J m.
- ------ --.,J- - -'8-r- - ----- chn. lowerio

and an t b e l y o t cfJ9>!Sttic A mentnt t.

low et"t.eeth
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

INNERVATION

MECHANICAL ORO-FACIAL DISTRICT

THERMAL

NOCICEPTIVE

INNERVATION

WITHIN THE TOOTH TOOTH

(NOCICEPTIVE)

PERIODONTAL
(MECHANICAL AND NOCICPETIVE)

INNERVATION
JAW AND MASTICATORY
PROPRIOCEPTIVE
MUSCLES
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

ANIMALS: OROFACIAL SENSITIVITY IS THE HIGHEST OF THE BODY.

EXPLORATIVE FUNCTIONS VERY HIGH IN IBRISSAE (IN CAT 1/3 OF AFFERENT TRIGEMINAL FIBERS)

HUMANS: EXPLORATIVE FUNCTION TAKEN BY THE HAND (WITH THE EXCEPTION OF POST -NATAL LIFE)
INCREASE OF HAND CORTICAL REPRESENTATION (THE TRIGEMINAL REMAINS LARGE!)

SENSORY ACUITY
1.5-1.7mm
10mg

MAXIMAL IN MEDIAL LIP PORTION

DECREASES

MINIMAL AT PHARYNX

*
* *
sensory perception in oro-facial district: mechanosensation

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT: MECHANOCEPTION

INFORMATION ON:
INITIAL CONSISTENCE AND
PROGRESSIVE MODIFICATION OF FOOD
PHYSICAL PROPERTIE OF SUBSTANCES IN MOUTH
IN MOUTH DURING MASTICATORY
FUNCTION

TISSUE DEFORMATION/STRETCH
PROPOIOCEPTORS SIGNALLING
POSTITION AND MOVEMENTS OF
STRUCTURES ACTIVE IN MASTICATORY
FUNCTION

ROLE

SENSORI-MOTOR CONTROL
ANESTHESIA: 1) ANALGESIA, AND LOSS OF MOTOR CONTROL IN OROFACIAL MUSCLES
2)APRAXIA OF SPEECH
3) SALIVARY INCONTINENCE
4)LOSS OF THE ABILITY TO RECOGNISE THE DIFFERENT STRUCTURE OF THE OWN MOUTH
(TONGUE, CHEEKS) FROM FOOD

FOOD CHARACTERIZATION WITH HIGH ACUITY GIVING RISE TO A WIDE RANGE OF SENSATIONS
(INTEGRATION OF INFORMAITON FORM THE TOOTH AND THE MOUTH) NOT COMPARABLE TO ANY OTHER
BODY DISTRICT
FLAVOUR OF FOOD ALSO NEEDS OLFACTION AND TASTE TO BE COMPLETE!

SOME MECHANORECEPTOR MAY INDUCE TASTE SENSATIONS!

sensory perception in oro-facial district: mechanosensation

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:

THE MECHANORECEPTORS
1. MESSNER*
2. MERKEL
3. RUFFINI
4. HAIR FOLLICLE RECEPTORS*
5. PACINI (RARE) (VENTRAL SIDE OF TONGUE EXCEPTION!)
6. LOW TRESHOLD MECHANOCEPTORS **

SENSORY AXONS ARE ORGANIZED IN

BUNDLES.
FASCICLE FIELD: INNERVATION
TERRITORY OF INDIVIDUAL FASCICLES
(BUNDLES)
sensory perception in oro-facial district: mechanosensation

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:

THE TWO POINT THRESHOLD DISCRIMINATION

FACE INNERVATION HAND FOREARM SKIN INNERVATION

TONGUE INNERVATION FINGER TIP INNERVATION

VARIABLE TRESHOLD WITHIN THE DIFFERENT CLASSES FO RECEPTORS!!

 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
MECHANORECEPTIVE SIGNALS DURING OROFACIAL MOTOR ACTIVITIES

ACTIVATION DURING NATURAL MOVEMENT : PROPRIOCEPTIVE ROLE!

FACIAL MUSCLES WITHOUT PROPRIOCEPTION!

ACTIVATION DURING SPEECH GESTURES

ACTIVATION DURING CHEWING MOVEMENTS

AUDIO SIGNAL CHEWING

MOVEMENT

FILTERED NERVE FILTERED NERVE

SIGNAL SIGNAL
MICROELECTRODE
MICROELECTRODE
RECORD
RECORD

CHEWING
MOVEMENT
AUDIO SIGNAL
MICROELECTRODE
MICROELECTRODE RECORD
RECORD
ISTANTANEOUS
ISTANTANEOUS DISCHARGE
DISCHARGE

AFFERENT ACTIVITY DURING AFFERENT ACTIVITY DURING

SPEECH CHEWING
sensory perception in oro-facial district: mechanosensation

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:

MECHANORECEPTIVE SIGNALS DURING OROFACIAL MOTOR ACTIVITIES

ACTIVATION DURING NATURAL MOVEMENT : PROPRIOCEPTIVE ROLE!

TONGUE MOVEMENTS
FAST ADAPTING
RECEPTOR AND ITS
ISTANTANEOUS DISCHARGE RECEPTIVE FIELD

MOVEMENT OF THE
TONGUE: THE
RECEPTIVE FIELD GETS
IN CONTACT WITH THE
LOWER INCISOR
TOOTH
NERVE RECORDING

SLOW ADAPTING
DEEP RECEPTOR AND
ITS RECEPTIVE FIELD

OUTWARD AND
INWARD MOVEMENT
OF THE TONGUE: THE
RECEPTIVE
DISCHARGES WHEN
THE SUBJECT
PROTRUDED THE
TONGUE
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

INNERVATION

MECHANICAL ORO-FACIAL DISTRICT

THERMAL

NOCICEPTIVE

INNERVATION

WITHIN THE TOOTH TOOTH

(NOCICEPTIVE)

PERIODONTAL
(MECHANICAL AND NOCICPETIVE)

INNERVATION
JAW AND MASTICATORY
PROPRIOCEPTIVE
MUSCLES
 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
THE THERMAL RECEPTORS

1. ROLE

FOOD TASTE / ENJOYIMENT OF FOOD

FOOD TASTE DEPENDS ON THE CHANGES IN TEMPERATURE OCCURRING IN THE MOUTH INDUCED BY THE
FOOD (ES. TEMPERATURE AFFECTS ODORNANTS DISPERTION, MODIFIES THE VISCOSITY OF FOOD, INCREASES
THE ACCESSIBILITY OF THE CHEMICALS ON TASTE BUDS/RECEPTORS).

ACTIVATION OF REFLEX BEHAVIOURS

THE SIGNALS RESULT IN REFLEXES AND BEHAVIOURS THAT PREVENT US FROM COMSUMING SUBSTANCES
THAT CAN BURN OR FREEZE OUR ALIMENTARY CANALS OR CAN ADVERSELY ALTER THE CORE BODY
TEMPERATURE AND HOMEOSTASIS
 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
THE THERMAL RECEPTORS

2. PERCEPTION OF TEMPERATURE depends on:

1. FOOD TEMPERATURE

CHANGES OCCURRING IN 29-37C RANGE (NEUTRAL SKIN AND MUCOLSAL TEMPERATURE) ARE NOT PERCEIVED OR
RAPIDLY ADAPTING (CEASES TO BE PERCEIVED IN 1 MINUTE)

INCREMENTS > 37C PERSISTING SENSATION OF WARM **HEAT PAIN*

DECREMENTS < 29C PERSISTING COOL-COLD COLD PAIN

2. FOOD PHYSICAL AND TEXTURAL PROPERTIES.

DIFFERENT FOODS INTRODUCED IN THE MOUTH AT THE SAME TEMPERATURE MAY EVOKE DIFFERENT THERMAL
SENSATIONS:
HIGH-FAT FOODS (LOW THERMAL CONDUCTIOVITY AND HIGH VISCOSITY) ARE PERCEIVED AS WARMER WITH
RESPECT TO LOW-FAT FOODS AND WATER

3. MANNER IN WHICH THE FOOD IS MANIPULATED IN THE MOUTH

4. BASAL TEMPERATURE OF THE MOUTH WHEN WE INTRODUCE FOOD

**TEMPERATURE OF THE TONGUE

CORRESPONDS TO 37C WITH OPEN
MOUTH , THAT IS WHY MOUTH IS
PERCEIVED WARMED WITH THE
MOUTH CLOSED.
 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
THE THERMAL RECEPTORS
FUNCTIONAL PROPERTIES OF THERMAL RECEPTORS

RESTING BASELINE TEMPERATURE OF FACIAL SKIN 33-34C (FINGERS 30-33C)

MUCOSAL SURFACES OF THE LIPS 34-35C
TONGUE36-37C (INCREASES WITH CLOSED LIPS)

FOOD INTRODUCED IN
MOUTH CONTACT WITH TISSUES IN MOUTH/FACE CHANGE IN TEMPERATURE
DUE TO TRANSFER OF
ENERGY

DEPENDING ON:
1. THICKNESS OF EPITHELIUM
2. DEGREE OF KERATINIZATION
3. AMOUNT AND QUALITY OF SALIVA

MYELINATED AND UNMYELINATED AXONS IN THE BASAL AND DEEPER LAYER OF EPITHELIUM

SENSORY ENDINGS WITH CHANNELS SENSITIVE TO TEMPERATURE CHANGES BUT ALSO CHEMICAL
COMPOUNDS

Es. RECEPTORS T>41C VR1 (vanillinoid receptor subtype 1)

RECEPTORS T>50C VRL-1 (vanillinoid receptor-like type1)
RECEPTORS T=8-28C CMR1 (cold menthol receptor type1)

CHILI WARM
MENTHOLCOOL HOT AND COLD FOOD!
 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
THE THERMAL RECEPTORS
1. COLD RECEPTORS(A ) (LOW TRESHOLD COLD RECEPTORS)
2. WARM RECEPTORS(C)

1. SMALL (PUNCTIFORMS) RECEPTIVE FIELDS (300 m diameter)

2. THRMAL SENSITIVITY IS NOT CONTINUOUS BUT PUNCTATE IN NATURE (SKIN IS A MOSAIC OF COLD
AND WARM THERMOSENSITIVE SPOTS SURROUNDED BY THERMALY INSENSITIVE AREAS )
3. ONE THERMAL SPOT NOT NECESSARILY CORRESPONDS TOTHE RECEPTIVE FIELD OF ONE RECEPTOR
4. OROFACIAL REGION IS BETTER EQUIPPED TO PROCESS INFORMATION ABOUT COOLING THAN
ABOUT WARMING (HIG DENSITY FOR COLD RECEPTORS, FASTER!)

PARADOXICALLY LESS
INTENSE!! BURST!!
 SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT:
THE THERMAL RECEPTORS
SENSITIVE TO RAPID WARM RECEPTORS COLD RECEPTORS
CHANGES IN TEMPERATURE LOW DENSITY HIGH DENSITY
AS FUNCTION OF
1. BASAL TEMPERATURE
2. RATE OF TEMPERATURE
CHANGE
3. FINAL TEMPERATURE

ALSO HIGH TRESHOLD

THERMAL RECEPTORS
Nociceptors and HTCRs
 THERMAL PERCEPTION (PSYCHOPHYSICS)

WARMING: EXTRAORAL SKIN LESS SENSITIVE THAN THE INTRAORAL SURFACE

COOLING: COMPARABLE SENSITIVITY INTRA AND EXTRA-ORAL
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

INNERVATION

MECHANICAL ORO-FACIAL DISTRICT

THERMAL

NOCICEPTIVE

INNERVATION

WITHIN THE TOOTH TOOTH

(NOCICEPTIVE)

PERIODONTAL
(MECHANICAL AND NOCICPETIVE)

INNERVATION
JAW AND MASTICATORY
PROPRIOCEPTIVE
MUSCLES
 Oro-facial sensory innervation

Nociception and pain perception in oro-facial district

 NOCICEPTION AND PAIN PERCEPTION IN ORO-FACIAL DISTRICT

POPULATION

1-2% FACIAL PAIN 8% TEMPORO MUSCOLAR DISORDERS 11-12% TOOTHACHE

WOMEN > MEN

NOCICEPTORS: FREE ENDINGS A -C

SPECIFIC AFFERENCES FROM:

TOOTH PULP

PRIODONATL LIGAMENT: A -C

ORAL MUCOSA: A -C

FACE SKIN

TMJ AND MASTICALTORY MUSCLES

CRANIAL VESSELS
NOCICEPTION AND PAIN PERCEPTION IN ORO-FACIAL DISTRICT
NOCICPETORS

RECEPTIVE FIELD1-2mm
NOCICEPTION AND PAIN PERCEPTION I N ORO-FACIAL DISTRICT
NOCICPETORS
A

1 ms 1 ms

il
/
111r "
\
Eleet rieal
09 g 058 stlmulus
von Frey filament
artifact

Sms
Fig. 1. R-ecordings from a low-t.hresho ld C unit. in the huma.n supraorbital nerve. A ,
response t o a von Frey filament of(){)9 g, and to eleetrieal intraderma.l st.imulation. Note
(abovc) that the;, n'H)C-ha.niea.Uy and ele-etrieally evoked nerve tt.etion potentials,
aupcr-impoacd o n t h c bD.Ckground noi&oe, we r e a im ilar. T h e l&t.en cy or t h e n>fSJ)On
tQ
electrical st.imula.t.ion was about 53 ms, which corresponded to a conduct on velocity of
13 mjs . 8 , this latency waa increased by simu1taneous mecha.nical actvation, further
indicating that. the sarne un it wfU; responding . T went.)HJeven consecutive responses to
electrical stimuli delivered a.t a rate of09/s a,re shown from above to below. Th e- initia l
44 ms of the post.s timulus period ha.ve been omiu.ed. The aaterisks indicate a. period of
pressure in t he receptive field. The arrow pointi to one of the rn hanic-ally evoked
discharges .
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

INNERVATION

MECHANICAL ORO-FACIAL DISTRICT

THERMAL

NOCICEPTIVE

INNERVATION

WITHIN THE TOOTH TOOTH

(NOCICEPTIVE)

PERIODONTAL
(MECHANICAL AND NOCICPETIVE)

INNERVATION
JAW AND MASTICATORY
PROPRIOCEPTIVE
MUSCLES
Oro-facial sensory innervation.

Teeth innervation
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

TEETH INNERVATION

ENAMEL

TOOTH PULP

DENTINE

PERIODONTAL
LIGAMENT

PULP

CEMENTUM

DENTINE
TUBULES
NERVOUS FIBERS
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

TEETH INNERVATION
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

TEETH INNERVATION

Table 2. Sensory Afferent Fibres of Norma l Teeth.

A-P Fibre A-8 Fibre A-8 Fibre C fibre
(Insensitive to
hydrodynamic
stimulation)
Location Dentine Denti ne Pulp Pulp
Functi on TactiJe sensitivity Tactile sensitiv ity Pain Pain
and pain and pain
Reflex Effect Vascular effects, Vascular effects, (Jaw (Jaw
Jaw opening in Jaw opening in Immobilisation) Immobilisation )
animals. ani mals.
Pain Quality Sharp, well- Sharp, well- Unclear Poorly-Jocali zed,
localized dentina! localized dentina! dull pain
pain pam
Hydrodynam ic Yes Yes No No
Reactivity
Response to Transien t Transient Yes Yes
Noxious Heat Response Response
Peptide CGRP CGRP CGRP CGRP
Expression Substa nce-P
Receptor P2X3 P2X 3 TRPVl TRPVl
Expression TRPV2 TRPV2 TRPV2 TRPV2

Note: The inform ation contained in this table only applies to dentine-pulp complex.
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

TEETH INNERVATION
FIBERS: UNMYELINATED (80%) DIAMETER < 1 m; MYELINATED, DIAMETER 2.5-3 m (20%)

CONDUCTION VELOCITY 0.8-30m/s

INNERVATION: SOMATOSENSORYAND VEGETATIVE (VESSEL)

TERMINALS IN DENITINAL TUBULES ARE ALL SENSITIVE

ADEGUATE STIMULI:

MECHANICAL
CHEMICAL
THERMAL
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION TEETH

INNERVATION AND SENSORY TRASDUCITON

3 THEORIES:

NEURAL THEORY: TRANSDUCTION IS MEDIATED BY FREE ENDINGS WITHIN DENTINAL

TUBULES(IN THE SAME WAY IN OTHER BODY PARTS)
PROBLEM: SIGNIFICANT DISTANCE BETWEEN THE STIMULUS AND THE NERVE ENDING

ODONTOBLAST THEORY: STIMULUS IS TRANSDUCED BY THE ODONTOBLAST PROCESS IN

DENTINAL TUBULES AND IS THEN TRANSFERRED TO THE NERVE ENDINGS WITHIN THE
DENTINE-PULP COMPLEX
PROBLEM: NO EVIDENCE OF SYMNAPSIS BETWEEN ODONTOBLASTS AND NERVE ENDINGS

HYDRODYNAMIC THEORY: THE STIMULATION OF DENTINE CAUSES THE FLUID IN THE

DENTINAL TUBULES TO MOVE. This fluid excites the mechanosensitive receptors on the nerve
endings in subodontoblastic plexus
THIS THEORY ACCOUNTS FOR MOST OF OBSERVATIONS RELATED TO TRANSDUCTION OF
VARIOUS STIMULI INTO PAIN IN THE DENTINE
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION TEETH

INNERVATION AND SENSORY TRASDUCITON

DENTINAL TUBULE

ODONTOBLAST PROCESS
AFFERENT
FIBER

Fluid movement Movement of the od. process

Mechanical deformation (K+ release)

DENTINE
AFFERENT
FIBER

ODONTOBLAST
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION TEETH

INNERVATION AND SENSORY TRASDUCITON

CLINICAL AND EXPERIMENTAL DATA IN HUMANS:

STIMULI APPLIED TO DENTINE OR PULP ARE ALWAYS PERCEIVED AS PAINFUL WHATHEVER THE
NATURE OF THE STIMULUS
ARE THERE OTHER SENSATIONS? NO EVIDENCE (SIMULI UNDERTRESHOLD FOR PAIN PAERCEPTION ARE REFEREED AS ASPECIFIC
TOUCH/THERMAL BUT COULD BE DUE TO THE SPREAD OF THE STIMULUS TO ADIACENT TISSUES)

STIMULI APPLIED OVER THE SURFACE OF THE TOOTH ARE NOT ENOUGH TO STIMULY RECEPTORS:
CHEMICAL STIMUL(SUGAR, SALTS, ACIDS, ANESTHETICS) MUST DIFFUSE IN TUBULI TO STIMULATE RECEPTORS
MECHANICAL STIMULI(PRESSURE) MUST BE TRASMITTED BY THE DENTINE TO THE PULP
THERMAL STIMULI ARE EFFICIENT ONLY WHEN THE DELTA IS EQUAL OR >10C
Sensory perception in oro-facial district

SOMATOSENSORY INNERVATION OF OROFACIAL DISTRICT

INNERVATION

MECHANICAL ORO-FACIAL DISTRICT

THERMAL

NOCICEPTIVE

INNERVATION

WITHIN THE TOOTH TOOTH

(NOCICEPTIVE)

PERIODONTAL
(MECHANICAL AND NOCICPETIVE)

INNERVATION
JAW AND MASTICATORY
PROPRIOCEPTIVE
MUSCLES
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

PERIODONTAL LEGAMENT AND SENSORY TRASDUCITON

FIX THE ROOTS OF THE TEETH TO THE ALVEOLAR BONE.

MINIMAL DEGREE OF FREEDOM IN MOVEMENT (NOT FIXED), NOT ONLY SUPPORT
DEVICE!
RICH SENSORY ORGAN (>300 LOW TRESHOLD RECEPTOR IN PERIODONTAL LIGAMENT
OF EACH TOOTH)

INFORMATION OF TOOTH LOADS

WHEN A FORCE IS APPLIED TO THE TOOTH, IT MOVES INTO THE SOCKET. THIS
MOVEMETN INDUCES STRESS AND STRAINS OF THE PERIODONTAL LIGAMENT

1. HORIZONATL FORCES (NO MESIO-DISTAL IF THERE ARE THE OTHER TEETH).

2. VERTICAL FORCES
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

PERIODONTAL LEGAMENT AND SENSORY TRASDUCITON
MECHANORECEPTORS
MYELINATED FIBERS
UNMYELINATED FIBERS (SOMATIC AND VEGETATIVE)

EVOKED SENSATION: CONTACT,

TOOTH DISTORTION PERCEPTUAL
TRESHOLD SOGLIA PERCETTIVA
1g FRONT TOOTH
6-7g MOLAR TOOTH
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

PERIODONTAL LEGAMENT AND SENSORY TRASDUCITON

3 PARAMETERS OF THE STIMULUS:

- TIME COURSE OF THE STIMULUS
- DIRECTION OF THE STIMULUS
- FORCE APPLIED TO THE TOOTH
Oro-facial sensory innervation. Teeth innervation

ORO-FACIAL SENSORY INNERVATION

PERIODONTAL LEGAMENT AND SENSORY TRASDUCITON

3 PARAMETERS OF THE STIMULUS:

- TIME COURSE OF THE STIMULUS
- DIRECTION OF THE STIMULUS
- FORCE APPLIED TO THE TOOTH
Neural substrates of the oro-facial pain

Central pathways
Neural substrates of the oro-facial pain. Central pathways

ORO-FACIAL SENSORY INNERVATION

TRIGEMNINAL NUCLEUS

FIBERS FROM THE 3 IPSILATERAL

BRANCHES

AFFERENCE VII E IX

GASSER GANGLION PRINCIPAL ROOT PRINCIPAL SENSITIVE NUCELUS

THROUGH GASSER GANGLION MESENCEPHALIC NUCLEUS

MECHANOREPTORS FROM PERIODONTAL LIGAMENT

MUSCLE SPINDLES ISPSILATERAL
Neural substrates of the oro-facial pain. Central pathways

ORO-FACIAL SENSORY INNERVATION

TRIGEMNINAL NUCLEUS
Neural substrates of the oro-facial pain. Central pathways

ORO-FACIAL SENSORY INNERVATION

TRIGEMNINAL NUCLEUS

1- PRIMARY SENSITIVE NUCLEUS

MYELINATED AFF

UNMYELINATED AFF

VII IX X

2-SPINAL COMPLEX
ORALIS SUBNUCLEUS

INTERPOLARIS SUBNUCLEUS

CAUDALIS SUBNUCLEUS

RETICULAR FORMATION
Neural substrates of the oro-facial pain. Centrai pathways

ORO-FACIAL SENSORY INNERVATION

TRIGEMNINAL NUCLEUS
L FT

Trig.tmil'Jal Gangl un (V)

Gcnicul..acc- Gangi ion fV Ili

Supt:rior G<mgl on (IJ\1

Superior 0Mgl ion (X)

ubnu lrms Or:.dis

.. ulbuueleus. lnferp.olori s
ulb-mucleus Caudaf s

I=IGURE 1 - Mechan i sm of Pa irn t ransm i ss ion in the trigem ina l syst em

( Ad a pted w ith permi ss ion of Dr. J _Harding. Univ. of Wiscornsin)
Neural substrates of the oro-facial pain. Centrai pathways

ORO-FACIAL SENSORY INNERVATION

TRIGEMNINAL NUCLEUS

Main sensory
nuclei

Dorsal
colum
n
nuclei

N. caudalis

e Figure 5. Schematic of the inverted representation of the face and mouth (of a cat, in this instance) in the different
subdivisions of the V brainstem nuclear complex. Each area of the ipsilateral face is represented at ali rostrocaudal
levels within the V brain stem complex. The projection s of ipsilateral limbs and trunk to the dorsal column nuclei
are also shown. (From Mountcastle, V.B. Medicai Physiology. Mosby, St. Louis, Vol.!, 1974.)
Neural substrates of the oro-facial pain. Central pathways
ORO-FACIAL SENSORY INNERVATION
TRIGEMNINAL NUCLEUS AND PATHWAYS

PRINCIPAL SENSITIVE NUCLEUS

TRIGEMINO-THALAMIC PATHWAY

DECUSSATION

TRIGEMINAL LEMNISCUS

THALAMUS VPM

SOMATOSENSORY CORTEX
Neural substrates of the oro-facial pain. Central pathways
ORO-FACIAL SENSORY INNERVATION
TRIGEMNINAL NUCLEUS AND PATHWAYS

SUBNUCLEUS ORALIS
TRIGEMINO-THALAMIC

BRAIN STEM NUCLEI

(RIFLEXES)

SUBNUCLEUS INTERPOLARIS TRIGEMINO-THALAMIC PATHWAYS

(SMALL PROPORTION)

CEREBELLUM (LOBE ANTERIOR)

(MOVEMENT CONTROL)

SUBNUCELUS CAUDALIS

TRIGEMINO-THALAMIC VPM E INTRALAMINAR NUCLEI (CROSSED)

INTRALAMINAR NUCLEI (IPSILATERAL)

CORTEX
PAIN: CAUDAL SUBNUCELUS ORGANIZATION

LAMINAE IN SUBNUCLEUS CAUDALIS

Z MARGINAL (MAR)
Z. SUBSTANTIA GELATINOSA (SG)
Z. MAGNOCELLULAR (MC)
Z. RETICOLAR

(SIMILAR TO LAMINAE IN DORSAL HORN..)

 PAIN: CAUDAL SUBNUCELUS ORGANIZATION

FUNCTIONAL PROPERTIES OF NEURONS

SPECIFIC (NOCICEPTIVE) AND ASPECIFIC (NOCICEPTIVE-TACTILE) NEURONS

1. NEURONS WITH WIDE SPECTRUM

2. NEURONS SPECIFIC NOCICEPTORS
3. NEURONS RECEIVING FROM TOOTH PULP
CENTRALPATHWAYS: THALAMUS

- - - - - --
 OROFACIAL PAIN: CENTRAL PATHWAYS

THALAMUS-CORTEX

ACQUEDOTTO
DORSAL RAPHE NUCLEUS

MESENCEPHALON

V SPINAL TRACT

PRINCIPAL NUCLEUS
ORAL SUBNUCLEUS
PONS
GASSER
V SPINAL TRACT

MEDULLA OBLONGATA
RAPHE MAGNO NUCLEUS