Department of Oral Biology, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
Med Hypotheses. 2010 May;74(5):835-40. doi: 10.1016/j.mehy.2009.11.044. Epub 2009 Dec 31.
Vital bleaching procedures are a popular means of improving the appearance of discolored teeth. There is a wide array of whitening products for home and dental office use; all involves placing peroxide containing gels or solutions in contact with the teeth. In order to whiten teeth peroxide has to be able to penetrate tooth structure and oxidize colored compounds in the dentin. Unfortunately beauty comes with a price; many patients undergoing peroxide based whitening procedures complain of bleaching sensitivity (BS) arising in the treated teeth. In BS, pain can occur in healthy intact teeth without any provoking stimulus. Currently the mechanism of nociceptors activation in BS is unknown. A more common form of dental pain-dentin sensitivity (DS) occurs when stimuli such as cold or tactile stimulation contact areas of exposed dentin in otherwise healthy teeth. In DS, stimulation of the dentin results in fluid shifts in the dentinal tubules, these fluid shifts activate mechanosensitive nerve endings in the deep dentin and pulp. Since many aspects of BS and DS symptoms differ, it is hypothesized that that the mechanism of pain generation differs for these two conditions. Recently the functional properties of a chemosensitive ion channel-TRPA1 have been described. This channel is activated by a variety of oxidizer compounds including hydrogen peroxide. Pulpal sensory afferents express TRPA1. It is hypothesized that direct activation of intradental nerve activity via TRPA1 is the mechanism of BS pain. If this theory were correct, tooth sensitivity treatments that reduce the excitability of the intradental nerves such as potassium salts, would be the treatment of choice for BS.
活髓漂白是改善变色牙齿外观的一种常用方法。有各种各样的家庭和牙科诊室使用的美白产品；所有这些产品都涉及将含有过氧化物的凝胶或溶液放置在牙齿上。为了使牙齿变白，过氧化物必须能够穿透牙体结构并氧化牙本质中的有色化合物。不幸的是，美丽是有代价的；许多接受过氧化物漂白的患者抱怨治疗牙齿出现漂白敏感（BS）。在 BS 中，即使没有任何刺激性刺激，健康完整的牙齿也会出现疼痛。目前，BS 中伤害感受器激活的机制尚不清楚。当冷或触觉刺激接触暴露的牙本质区域时，更常见的牙齿疼痛形式-牙本质敏感（DS）会发生在健康的牙齿中。在 DS 中，牙本质的刺激会导致牙本质小管中的流体移位，这些流体移位会激活深牙本质和牙髓中的机械敏感神经末梢。由于 BS 和 DS 症状的许多方面不同，因此假设这两种情况的疼痛产生机制不同。最近，一种化学敏感离子通道-TRPA1 的功能特性已被描述。该通道可被多种氧化剂化合物激活，包括过氧化氢。牙髓感觉传入纤维表达 TRPA1。假设通过 TRPA1 直接激活牙内神经活动是 BS 疼痛的机制。如果这一理论是正确的，那么减少牙内神经兴奋性的牙齿敏感性治疗方法，如钾盐，将是 BS 的首选治疗方法。
