Tracing Toothache Intensity in the Brain

Brügger, Mike; Lutz, Kai; Brönnimann, Ben; Meier, Michael L.; Luechinger, Roger; Barlow, Ashley; Jäncke, Lutz; Ettlin, Dominik A

doi:10.1177/0022034511431253

Cited by 33 publications

(36 citation statements)

References 29 publications

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“…Specifically, recent studies utilizing fMRI have looked at brain activation of tooth pain (Weigelt et al 2010;Brugger et al 2012), virtual dental treatment (Said Yekta et al 2009), and dentin hypersensitivity . However, these studies are often limited by the fMRI machine itself from functional and financial aspects as well as its requirements for participants to be isolated and subject to complete stillness during the testing.…”

Section: Discussionmentioning

confidence: 99%

Different Brain Responses to Pain and Its Expectation in the Dental Chair

Raček

Nascimento

et al. 2015

J Dent Res

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A dental appointment commonly prompts fear of a painful experience, yet we have never fully understood how our brains react to the expectation of imminent tooth pain once in a dental chair. In our study, 21 patients with hypersensitive teeth were tested using nonpainful and painful stimuli in a clinical setting. Subjects were tested in a dental chair using functional near-infrared spectroscopy to measure cortical activity during a stepwise cold stimulation of a hypersensitive tooth, as well as nonpainful control stimulation on the same tooth. Patients' sensory-discriminative and emotional-cognitive cortical regions were studied through the transition of a neutral to a painful stimulation. In the putative somatosensory cortex contralateral to the stimulus, 2 well-defined hemodynamic peaks were detected in the homuncular orofacial region: the first peak during the nonpainful phase and a second peak after the pain threshold was reached. Moreover, in the upper-left and lower-right prefrontal cortices, there was a significant active hemodynamic response in only the first phase, before the pain. Subsequently, the same prefrontal cortical areas deactivated after a painful experience had been reached. Our study indicates for the first time that pain perception and expectation elicit different hemodynamic cortical responses in a dental clinical setting.

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Section: Discussionmentioning

confidence: 99%

Different Brain Responses to Pain and Its Expectation in the Dental Chair

Raček

Nascimento

et al. 2015

J Dent Res

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“…The methodological novelty and particular strength of the present study is that many confounders were eliminated by applying a constant and purely noxious stimulus to the tooth and subsequently blocking the nociceptive signaling by an articaine injection. The stimulus type selection was based on previous findings demonstrating that electrical dental pulp stimuli evoke sensory perceptions that are highly stable across time (Brown et al, 1985;Brugger et al, 2012;Meier et al, 2014). No pain rating was therefore required that could have caused blurring effects on fMRI findings due to cognitive and motor aspects of the rating.…”

Section: Discussionmentioning

confidence: 99%

“…Mandibular splints were fabricated from impressions made of Blu-Mousse (Blu-Mousse is a fastsetting vinyl polysiloxane material produced by Parkell, Inc., 300 Executive Drive, Edgewood, NY 11717, USA) (Brugger et al, 2011;Brugger et al, 2012;Meier et al, 2014). Stainless steel electrodes were embedded in each splint at the labial and lingual centers of the left mandibular canine.…”

Section: Dental Splintmentioning

confidence: 99%

The Human Brain Response to Dental Pain Relief

et al. 2015

Self Cite

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Local anesthesia has made dental treatment more comfortable since 1884, but little is known about associated brain mechanisms. Functional magnetic resonance imaging is a modern neuroimaging tool widely used for investigating human brain activity related to sensory perceptions, including pain. Most brain regions that respond to experimental noxious stimuli have recently been found to react not only to nociception alone, but also to visual, auditory, and other stimuli. Thus, presumed functional attributions have come under scrutiny regarding selective pain processing in the brain. Evidently, innovative approaches are warranted to identify cerebral regions that are nociceptive specific. In this study, we aimed at circumventing known methodological confounders by applying a novel paradigm in 14 volunteers: rather than varying the intensity and thus the salience of painful stimuli, we applied repetitive noxious dental stimuli at constant intensity to the left mandibular canine. During the functional magnetic resonance imaging paradigm, we suppressed the nociceptive barrage by a mental nerve block. Brain activity before and after injection of 4% articaine was compared intraindividually on a group level. Dental pain extinction was observed to correspond to activity reduction in a discrete region of the left posterior insular cortex. These results confirm previous reports demonstrating that direct electrical stimulation of this brain region-but not of others-evokes bodily pain sensations. Hence, our investigation adds further evidence to the notion that the posterior insula plays a unique role in nociceptive processing. The human brain response to dental pain relief AbstractLocal anesthesia has made dental treatment more comfortable since 1884, but little is known about associated brain mechanisms. Functional magnetic resonance imaging (fMRI) is a modern neuroimaging tool widely used for investigating human brain activity related to sensory perceptions, including pain. Recently, most brain regions that respond to experimental noxious stimuli have been found to react not only to nociception alone, but also to visual, auditory and other stimuli. Thus, presumed functional attributions have come under scrutiny regarding selective pain processing in the brain. Evidently, innovative approaches are warranted to identify cerebral regions that are nociceptivespecific. In this study, we aimed at circumventing known methodological confounders by applying a novel paradigm in 14 volunteers: rather than varying the intensity and thus the salience of painful stimuli, we applied repetitive noxious dental stimuli at constant intensity to the left mandibular canine.During the fMRI paradigm we suppressed the nociceptive barrage by a mental nerve block. Brain activity before and after injection of 4% articaine was compared intra-individually on a group level.Dental pain extinction was observed to correspond to activity reduction in a discrete region of the left posterior insular cortex. These results confirm previous reports dem...

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“…This stimulation has been proven to evoke reliable sharp and pricking pain sensations (Keller et al, 2002; Brugger et al, 2011, 2012). The Presentation® software (http://www.neurobs.com/presentation) was used to control the experimental protocol.…”

Section: Methodsmentioning

confidence: 99%

Equal painâ€”Unequal fear response: enhanced susceptibility of tooth pain to fear conditioning

Meier

Matos

Brügger

et al. 2014

Front. Hum. Neurosci.

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Experimental fear conditioning in humans is widely used as a model to investigate the neural basis of fear learning and to unravel the pathogenesis of anxiety disorders. It has been observed that fear conditioning depends on stimulus salience and subject vulnerability to fear. It is further known that the prevalence of dental-related fear and phobia is exceedingly high in the population. Dental phobia is unique as no other body part is associated with a specific phobia. Therefore, we hypothesized that painful dental stimuli exhibit an enhanced susceptibility to fear conditioning when comparing to equal perceived stimuli applied to other body sites. Differential susceptibility to pain-related fear was investigated by analyzing responses to an unconditioned stimulus (UCS) applied to the right maxillary canine (UCS-c) vs. the right tibia (UCS-t). For fear conditioning, UCS-c and USC-t consisted of painful electric stimuli, carefully matched at both application sites for equal intensity and quality perception. UCSs were paired to simple geometrical forms which served as conditioned stimuli (CS+). Unpaired CS+ were presented for eliciting and analyzing conditioned fear responses. Outcome parameter were (1) skin conductance changes and (2) time-dependent brain activity (BOLD responses) in fear-related brain regions such as the amygdala, anterior cingulate cortex, insula, thalamus, orbitofrontal cortex, and medial prefrontal cortex. A preferential susceptibility of dental pain to fear conditioning was observed, reflected by heightened skin conductance responses and enhanced time-dependent brain activity (BOLD responses) in the fear network. For the first time, this study demonstrates fear-related neurobiological mechanisms that point toward a superior conditionability of tooth pain. Beside traumatic dental experiences our results offer novel evidence that might explain the high prevalence of dental-related fears in the population.

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Tracing Toothache Intensity in the Brain

Cited by 33 publications

References 29 publications

Different Brain Responses to Pain and Its Expectation in the Dental Chair

Different Brain Responses to Pain and Its Expectation in the Dental Chair

The Human Brain Response to Dental Pain Relief

Equal painâ€”Unequal fear response: enhanced susceptibility of tooth pain to fear conditioning

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