Dental Pain

What is Pain ?

P

ain : an unpleasant sensory or emotional experience associated

with actual or potential tissue damage.

N

ociception : the activation of neural pathways by stimuli that

damage or threaten to damage the tissues.

D

ental Pain ( Toothache): any Pain or soreness within or around a

tooth, indicating inflammation and possible infection.

T

ooth Decay

P

ulp Inflammation

P

reapical Pathology

G

um Disease

I

mpacted Tooth

D

ry Socket

Causes of Dental Pain

T

ooth Fracture/Trauma

T

MJ Disorders/Malocclusion

S

inus Cold/Infection

T

ooth wear

Severe throbbing pain

Dull aching pain

Strong bearable pain

According to the degree of severity; pain can be divided into three types :

Pain Pathway

The stimulus is first received by

both the myelinated and

unmyelinated fibers of the

trigeminal nerve, which is the

principal sensory nerve of the

head region. The stimulus is

then conducted as an impulse

along the afferent fibers to the

semi-lunar or gasserian

ganglion.

Pain Pathway

The impulse is then

mediated by the sensory

root of the nerve into the

pones. In the pones the

sensory root either ends

directly into the “Principle

Sen sory Nucleus” or

bifurcate into ascending and

descending fibers.

Pain Pathway

The ascending fibers convey

general tactile sensation while

the descending fibers convey

temperature and pain sen sation.

The pain impulse descends from

the pones via the spinal tract

fibers of the trigeminal nerve,

through the medulla down to

about the level of the second

cervical vertebra where it enter

the “Accessory Sensory Nucleus”

Pain Pathway

Axones of the second neuron

emerges from the spinal nuclei,

cross the midline and ascend to

join the fibers of the

mesencephalic nucleus to form

the trigeminal Leminscus or

the spinothalamic tract. The

spinothalamic tract continue up

wards and terminate in the

posterioventral nucleus (PVN)

of the thalamus.

Pain Pathway

On reaching the PVN the

pain impulse is conveyed to

the third neuron. Fibers of

the third neuron projects

from the PVN to the

posterior central convolution

of the posterior cortex

where pain sensation is felt.