Applications of sensory and physiological measurement in oral‐facial dental pain

Abstract

Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.

Central mechanisms of pain in orofacial pain patients: Implications for management

“…These characteristics are consistent with the inclusion of TMD in CSS/COPCs 7,43,49 . QST in COPC, including TMD, demonstrate widespread hypersensitivity, hyperalgesia and allodynia in both painful and pain-free sites throughout the body, reinforcing the evidence of CS in the pathophysiology of these disorders 42,50,51 . As such it is important to recognize when these phenomena are present, in order to adequately address the patient's pain with respect to the overriding etiology, whether it be peripheral, central, or a combination of both.…”

“…CS, as previously described, is a phenomenon which refers to the neuroplastic changes that lead to temporal summation, hyperalgesia, and allodynia, and altered descending inhibition mechanisms, all of which may be a part of an important adaptive protective process to permit healing of damaged tissue in the acute setting. Because altered CNS pain processing is a hallmark feature of CS, an important tool for analyzing the presence of CS is Quantitative Sensory Tests (QST) which uses calibrated sensory stimuli to quantify detection thresholds which may be noxious or innocuous and is of value in evaluating orofacial pain 36,42 . Furthermore, CS is involved in chronic and dysfunctional (nociplastic) pain states with influence from psychosocial parameters, thus characterizing a maladaptive process 1 .…”

Pain perception genes, asthma, and oral health: A reverse genetics study

“…Nociceptive pain, which is characterized by the acute stimulation of nociceptors found in the skin, intraoral cavity, and dental pulp, is considered the most common type of pain in the orofacial region and the reason why patients usually seek dental care [ 3 ].…”

Efficacy Of Lidocaine And Xylometazoline Intranasal Spray In Anesthetizing Maxillary Teeth: An Open Label Randomized Controlled Trial

“…6 The development of safe and effective anesthesia is regarded amongst the most important advancements made in medical and dental practice. 7 Pain control has never been as e cacious as it is today. Mankind has been testing various methods to provide pain control.…”