Laser Doppler flowmetry was applied to human teeth to study whether blood How in the pulp can be recorded. In sensitive, intact incisors the level of the output signal Ironi the flowmeter was clearly distinguishable from that obtained in adjacent nonsensitive or pulpeetomized teeth. Heart beat synchronous oscillations, which were present in the recording signal from normal teeth, were absent in nonvital teeth. Local injection of lidocaine (20 mg/ml) with adrenaline (12.5 μg/ml) caused a pronounced and long‐lasting reduction of the flowmetric values in healthy teeth. The oscillations were also reduced in amplitude. Repeated recordings showed good reproducibility. Thus, changes in blood (low may be assessed in a tooth by tin's non‐invasive method. The instrument is a promising tool in the clinical evaluation of pulp vitality following traumatic injuries.
Gazelius B, Olgart L, Edwall B. Restored vitality in luxated teeth assessed by laser Doppler flowmeter. Endod Dent Traumatol 1988; 4: 265-268. Abstract -Revaseularization of the pulps in 4 luxated lower ineisors in an 11-year-old boy was demonstrated with a laser Doppler flowmeter. Pulpal blood flow arrested at the 1-week control was partly restored at 6 weeks and reached normal values 9 months after the trauma. Pulpal obliteration was recognized after 9 months and was pronouneed at the 1-year atid 2-year controls. Eleetrometrie sensitivity started to appear in 3 of the teeth at 9 months and was further restored in all teeth at the 1-year and 2-year controls.
Substance P (SP)- and calcitonin gene-related peptide (CGRP)-immunoreactivity (-IR) were localized by immunohistochemistry in the same nerve cell bodies in the trigeminal ganglia as well as in nerve terminals of the dental pulp. The distribution of SP- and CGRP-IR nerves were identical in the dental pulp and mainly associated with blood vessels. The level of CGRP-IR in the dental pulp, as measured by radio-immunoassay (RIA), was 1.4 +/- 0.2 pmol g-1 wet wt, which is in the same range as that found for substance P. Local intra-arterial infusion of synthetic CGRP and substance P produced vasodilatation in the dental pulp as measured by both laser Doppler flowmetry and an 125I clearance technique. The CGRP was effective as a vasodilator when infused in the femtomole per minute range, and SP in the picomole range. The effect of CGRP (50 fmol min-1) was 10 times larger when given after SP (15 pmol min-1) than before it. Since the two peptides coexist in the same neurons, it is suggested that they both contribute to the vasodilation seen upon antidromic stimulation of sensory nerves.
Neuropeptide Y (NPY) immunoreactivity (-IR) was found to be present in perivascular nerves in the cat dental pulp and oral mucosa. Many ganglion cells in the superior cervical ganglion also contained NPY-IR. Ligation of the inferior alveolar or lingual nerves produced an accumulation of NPY-IR in axons proximal to the site of ligation, suggesting an anterograde axonal transport of the peptide. After unilateral sympathectomy the NPY-IR disappeared in the dental pulp and oral mucosa on the ipsilateral side. Reversed phase high performance liquid chromatography showed that the main peak of NPY-like immunoreactivity found in the superior cervical ganglion co-chromatographed with synthetic porcine NPY. Changes in blood flow in dental pulp or oral mucosa were measured indirectly by recording local clearance of 125I during electrical stimulation of the sympathetic nerve or during close intra-arterial infusion of noradrenaline or NPY. All three procedures resulted in a pronounced decrease in local blood flow of a similar magnitude in both tissues. After alpha-adrenoceptor blockade with phentolamine, the vasoconstrictor effect of noradrenaline was abolished. However, the effect of sympathetic stimulation after phentolamine was only partially reduced (23-54%) and the response to NPY was almost unaffected by the alpha-receptor blockade. The remaining effect of sympathetic stimulation after phentolamine was abolished by guanethidine. However, the response to NPY was not changed by the latter drug. In conclusion, the vasoconstrictor response in the dental pulp and oral mucosa caused by activation of sympathetic nerves is more resistant to phentolamine than the response induced by infusion of exogenous noradrenaline. Since NPY is probably co-localized with noradrenaline in the sympathetic perivascular nerves and NPY reduces local blood flow, it is proposed that this peptide is involved in sympathetic vascular control in oral tissues.
Blood flow changes in the dental pulp of lower canine teeth of mature cats and incisors of mature rats were investigated with simultaneous laser Doppler flowmetry and local 125I-clearance (wash-out) during electrical sympathetic stimulation, efferent stimulation of n. alveolaris inferior (IAN) (cats) and i.a. infusions of substance P (SP) (cats). Stimulation (1-4 Hz, 4 V., 1.5 ms) of the cervical sympathetic trunk produced frequency-dependent decreases in both laser Doppler output and disappearance rate of iodine tracer from the dental pulp. For the effects of sympathetic stimulation, the correlation (r2) between the results obtained by the two methods was 0.89 (12 observations, six animals). Blood flow measurements by both methods were increased following i.a. infusions of SP (r2 = 0.64, six observations, three animals). However, upon stimulation of IAN (10 Hz 10 V, 5 ms) the laser Doppler flow values showed an increase while the local 125I clearance rate was unaffected or even decreased. The discrepancy between the results obtained following IAN stimulation indicates that the two methods reflect blood flow changes in different parts of the pulpal vascular bed and that the flow is unevenly distributed to these parts during antidromic IAN stimulation. The laser Doppler flowmetry seems to reflect the total blood flow in the coronal pulp and therefore this non-invasive method may be useful for monitoring blood flow changes in the tooth.
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