Local control of pulpal nociceptor activation
Perplexing clinical conclusion that pulpitis can often lead to complete pulp necrosis without any symptoms. Recent studies have revealed a number of local mediators in peripheral tissues, which regulate the inflammatory processes and, consequently, the sensitivity of nociceptors (48, 56). In the pulp of the tooth, for example, peripheral endogenous opioids, somatostatin and norepinephrine it was suggested to have two consequences(10, 19, 44, 48). As mentioned another mediator sympathetic fibers seems to inhibit the release of CGRP and, thus, may lead to a slowdown of the inflammatory reaction and nociceptor activation (17, 20, 54). noted that the release of the mediators is closely connected with concrete steps in the inflammatory process and governed through a negative feedback (48). The inhibitory factors may be needed to reduce inflammatory reaction and at the same time, they prevent the activation of the tooth pulp nociceptors. In addition, environmental changes as a result of changes in local blood flow able to change in response intradental nerves (43, 46).
In addition to these local factors in the pulp and paper tissue itself, a large number of chemical agents released from the carious lesions in carious teeth and removal from the surface of the dentin through patent tubules may modulate the neurological activity (46).
Thus, numerous local mechanisms can influence the intensification of intradental nerves and contributes to the wide variability symptoms of pulpitis. ..