Potential Novel Strategies for the Treatment of Dental Pulp-Derived Pain: Pharmacological Approaches and Beyond

Abstract

The diagnosis and management of pain is an everyday occurrence in dentistry, and its effective control is essential to ensure the wellbeing of patients. Most tooth-associated pain originates from the dental pulp, a highly vascularized and innervated tissue, which is encased within mineralized dentin. It plays a crucial role in the sensing of stimuli from the local environment, such as infections (i.e. dental caries) and traumatic injury, leading to a local inflammatory response and subsequently to an increase in intra-pulp pressure, activating nerve endings. However, thermal, chemical, and mechanical stimuli also have the ability to generate dental pulp pain, which presents mechanisms highly specific to this tissue and which have to be considered in pain management. Traditionally, the management of dental pulp pain has mostly been pharmacological, using non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, or restorative (i.e. removal of dental caries), or a combination of both. Both research areas continuously present novel and creative approaches. This includes the modulation of thermo-sensitive transient receptor potential cation channels (TRP) by newly designed drugs in pharmacological research, as well as the use of novel biomaterials, stem cells, exosomes and physical stimulation to obtain pulp regeneration in regenerative medicine. Therefore, the aim of this review is to present an up-to-date account of causes underlying dental pain, novel treatments involving the control of pain and inflammation and the induction of pulp regeneration, as well as insights in pain in dentistry from the physiological, pharmacological, regenerative and clinical perspectives.

Dental care management during the COVID‐19 outbreak

“…At present, NSAIDs are commonly prescribed for dental pain management, which can have side effects for many patients or drug interferences in case of pandemics. Some novel medications such as nociceptive temperature‐sensitive receptors‐targeting drugs have shown promising results so far but require further clinical investigations 57 …”

Pharmacological Approaches and Regeneration of Bone Defects with Dental Pulp Stem Cells

“…Therapeutic management of sensitive and painful regions after surgery is an important aspect affecting the results of stem cell therapy. Current pharmacological management of pain arising from inflammation at the site of implantation utilizes several approaches; the most frequently used are anti-inflammatory drugs (NSAIDs), opioids, and N-methyl-d-aspartic acid (NMDA) receptor blockers [ 47 ].…”

Nanostructured platelet-rich plasma: state of art in dental treatments

“…A recent review reported that exosomes appeared to be a promising alternative to cell therapy focused on treating dental pulp pain and inflammation, as well as to induce pulp regeneration. Nevertheless, benefits deriving from exosome use strongly depend on recipient cells, which could be an issue in patients presenting necrotic dental pulp or in the ones subjected to pulpectomy [25].…”