Abd-Elmeguid Ashraf, Yu Donald C
Department of Dentistry, University of Alberta, Edmonton, Canada.
J Can Dent Assoc. 2009 Feb;75(1):55-9.
Diagnosis in endodontics requires an understanding of pulpal histology, neurology and physiology, and their relationship to the various diagnostic tests commonly used in dental practice. Thermal changes in the oral environment cause rapid displacement of dentinal tubular contents, resulting in pain. This effect, known as the hydrodynamic effect, is the regulator of pain sensation in thermal-pulp testing. Hundreds of axons enter the tooth from the apical foramen to provide it with its sensory supply. The nerve supply of the dentin-pulp complex is mainly made up of A fibres (both delta and beta) and C fibres. They are classified according to their diameter and their conduction velocity. The A fibres are mainly stimulated by an application of cold, producing sharp pain, whereas stimulation of the C fibres produces a dull aching pain. Because of their location and arrangement, the C fibres are responsible for referred pain. This first part of a 2-part review examines the relation between clinical sensations during the diagnostic visit and the neurophysiology of the dental pulp to explore the connection between the art (clinical diagnosis) and the science (neurophysiology) of endodontics.
牙髓病诊断需要了解牙髓组织学、神经学和生理学，以及它们与牙科临床常用的各种诊断测试之间的关系。口腔环境中的温度变化会导致牙本质小管内容物迅速移位，从而引发疼痛。这种效应被称为流体动力效应，是热牙髓测试中疼痛感觉的调节因素。数百条轴突从根尖孔进入牙齿，为其提供感觉神经支配。牙本质 - 牙髓复合体的神经供应主要由A纤维（δ纤维和β纤维）和C纤维组成。它们根据直径和传导速度进行分类。A纤维主要受冷刺激，产生尖锐疼痛，而C纤维受到刺激时会产生钝痛。由于其位置和排列方式，C纤维会引发牵涉痛。这篇分为两部分的综述的第一部分探讨了诊断过程中的临床感觉与牙髓神经生理学之间的关系，以探索牙髓病学的艺术（临床诊断）与科学（神经生理学）之间的联系。
