Evidence gathered from our studies and the work of others appears to support the presence
of two distinct nerve pain pathways in the dental pulp, represented by fast conducting
A-delta and slow conducting C-fibers. Each of these types of fibers has different
pain characteristics: A-delta fibers evoke a rapid, sharp, lancinating pain reaction,
and C-fibers cause a slow, dull, crawling pain. Pain response thresholds vary in different
regions of the tooth, and thermal, osmotic, ionic, and electric stimuli involve different
mechanisms to provoke nerve excitation of the dental pulp. Evidence also points to
the fact that the incidence of pain increases as the histopathosis worsens. On interrogation,
patients who manifest severe or referred pain almost always give a previous history
of pain in the tooth with the ache. Eighty percent of patients who give a previous
history of pain manifest histopathologic evidence of chronic partial pulpitis with
partial necrosis, the untreatable category, for which endodontics or extraction is
indicated. The other 20% exhibit histopathosis of the pulp with slight inflammation
to chronic partial pulpitis without necrosis, a treatable category. Clinically, one
can determine the degree of pulp histopathosis by asking the patient about a previous
history of pain in the involved tooth. This history of previous pain adds another
dimension in diagnosis for the clinician as to whether the painful pulpitis is reversible.
This information also aids in referred pain localization.
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Article info
Footnotes
This study was supported by a grant from the I. B. Bender Research Endowment Fund, Albert Einstein Medical Center (Philadelphia, PA).
Identification
Copyright
© 2000 The American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
