Department of Endodontics, Case School of Dental Medicine, Cleveland State University, Cleveland, Ohio.
Dental School University of Missouri-Kansas City, Kansas City, Missouri.
J Endod. 2021 Nov;47(11):1696-1702. doi: 10.1016/j.joen.2021.07.011. Epub 2021 Jul 22.
Although many clinical studies have reported on the prevalence of dental pain, far fewer studies have focused on the mechanisms of dental pain. This is an important gap because increased understanding of dental pain mechanisms may lead to improved diagnostic tests or therapeutic interventions. The aim of this study was to comprehensively review the literature on the mechanisms of dentinal sensitivity.
PubMed and Ovid were searched for articles that addressed dentinal pain and or pulpal sensitivity. Because of the breadth of research ranging from cellular/molecular studies to clinical trials, a narrative review on the mechanisms of dentinal sensitivity was constructed based on the literature.
Five various mechanisms for dentinal sensitivity have been proposed: (1) the classic hydrodynamic theory, (2) direct innervation of dentinal tubules, (3) neuroplasticity and sensitization of nociceptors, (4) odontoblasts serving as sensory receptors, and (5) algoneurons.
These theories are not mutually exclusive, and it is possible that several of them contribute to dentinal sensitivity. Moreover, pulpal responses to tissue injury may alter the relative contribution of these mechanisms. For example, pulpal inflammation may lead to neuronal sprouting and peripheral sensitization. Knowledge of these mechanisms may prompt the development of therapeutic drugs that aim to disrupt these mechanisms, leading to more effective treatments for pulpal pain.
尽管许多临床研究已经报道了牙痛的患病率，但很少有研究关注牙痛的机制。这是一个重要的空白，因为对牙痛机制的深入了解可能会导致诊断测试或治疗干预的改进。本研究的目的是全面回顾有关牙本质敏感性机制的文献。
在 PubMed 和 Ovid 上搜索了涉及牙本质疼痛和/或牙髓敏感性的文章。由于研究范围广泛，从细胞/分子研究到临床试验，因此根据文献构建了关于牙本质敏感性机制的叙述性综述。
已经提出了五种不同的牙本质敏感性机制：（1）经典流体动力学理论，（2）牙本质小管的直接神经支配，（3）伤害感受器的神经可塑性和致敏，（4）成牙本质细胞作为感觉受体，和（5）感觉神经元。
这些理论并非相互排斥，它们都可能导致牙本质敏感。此外，牙髓对组织损伤的反应可能会改变这些机制的相对贡献。例如，牙髓炎症可能导致神经元发芽和外周致敏。对这些机制的了解可能会促使开发旨在破坏这些机制的治疗药物，从而为牙髓疼痛提供更有效的治疗。
