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Review, Sensory and Motor Systems

Review of Literatures: Physiology of Orofacial Pain in Dentistry

Nattapon Rotpenpian and Pankeaw Yakkaphan
eNeuro 5 April 2021, 8 (2) ENEURO.0535-20.2021; DOI: https://doi.org/10.1523/ENEURO.0535-20.2021
Nattapon Rotpenpian
1Department of Oral Biology and Occlusion, Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand 90110
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Pankeaw Yakkaphan
2Department of Oral Diagnostic Science, Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand 90110
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    Figure 1.

    Overview of orofacial pain physiology.

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    Figure 2.

    Classification of orofacial pain.

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    Figure 3.

    The possible mechanisms of neuropathic pain.

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    Table 1.

    Difference in acute orofacial pain and chronic pain orofacial pain

    CharacteristicsAcute orofacial painChronic orofacial pain
    DurationOnsetSustained, persistent >3 months in humans
    CauseCaused by inflammation or injury of tissueCaused by inflammation, nerve damage and excessive or uncontrolled inflammation
    Cause has gone away or healedNo pain when normal healing occurs or is only temporary (pain disappears once stimulus is removed)Persistent pain and excessive, uncontrolled causes
    Signs and symptomsSudden, sharp, intense, localizedAching, diffused
    Physiologic responseAcute pain affects increased cardiovascular functions such as increased blood pressure and heart rate via sympathetic responseChronic pain affects physiological
    responses with adaptation behaviors or psychological responses such as depression and anxiety
    Examples in the orofacial area(1) Dental pain: pulpitis
    (2) Mucogingival pain
    (1) Neuropathic pain: trigeminal neuralgia, peripheral trigeminal nerve injury, postherpetic neuralgia
    (2) Chronic inflammatory pain: chronic pulpitis and apical lesions, temporomandibular disorder pain
    (3) Neurovascular pain: migraines, tension-type headaches
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    Table 2.

    Difference between nociceptive, inflammatory, and neuropathic pain

    CharacteristicsNociceptive orofacial painInflammatory orofacial painNeuropathic pain
    Causes and mechanism of pain pathwayNoxious stimulation at the peripheral nerve and transmitted by normal components of the sensory trigeminal nerveStrong noxious stimulus causes lesions in the tissue leading to local inflammation responses and increased inflammatory mediatorsCaused by nerve damage or injury and increased peripheral sensitization, structure change by increased sodium activation, calcium activity of nerves leading to ectopic discharges, and glia cell activation
    Nerve conditionNormal nerve structureNormal nerve structureAbnormal nerve structure
    StimulationResponse to noxious stimulus for protective and withdrawal responseResponse to noxious stimulus and increase of activity of peripheral nociceptors-Response to non-noxious and noxious stimulation
    -Spontaneous pain without stimulation because ectopic discharges occurred in damaged nerves
    ExampleHot soup contacting the oral mucosa immediately caused pain perception (heat/hot), and then they threw away this hot soup-Pulp necrosis with apical abscess
    -Temporomandibular joint capsulitis or synovitis is caused by joint inflammation. Joint pain and limitation of jaw movement develops afterward
    Peripheral trigeminal nerve injury is caused by nerve damage such as facial trauma accident or trigeminal neuralgia contributing to abnormal nerve structure and expression of severe shooting pain, intermittent patterns, and feels like electric shocks
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eneuro: 8 (2)
eNeuro
Vol. 8, Issue 2
March/April 2021
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Review of Literatures: Physiology of Orofacial Pain in Dentistry
Nattapon Rotpenpian, Pankeaw Yakkaphan
eNeuro 5 April 2021, 8 (2) ENEURO.0535-20.2021; DOI: 10.1523/ENEURO.0535-20.2021

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Review of Literatures: Physiology of Orofacial Pain in Dentistry
Nattapon Rotpenpian, Pankeaw Yakkaphan
eNeuro 5 April 2021, 8 (2) ENEURO.0535-20.2021; DOI: 10.1523/ENEURO.0535-20.2021
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  • Article
    • Abstract
    • Introduction
    • Physiology of the Orofacial Pain Pathway
    • Primary Afferent Neurons and Pathologic Changes in Trigeminal Ganglion
    • Brainstem Nociceptive Neurons
    • Higher Brain Function Regulating Orofacial Nociception
    • Classification of Orofacial Pain and Possible Mechanisms
    • Conclusion
    • Footnotes
    • References
    • Synthesis
    • Author Response
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Keywords

  • dentistry
  • neurophysiology
  • orofacial pain
  • pain
  • sensation
  • sensory function

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