Quantitative analysis of substance P, neurokinin A and calcitonin gene‐related peptide in gingival crevicular fluid associated with painful human teeth

Abstract

The aim of this study was to investigate the presence of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in the gingival crevicular fluid of teeth diagnosed with pain of pulpal origin compared with clinically healthy teeth, and to detect any changes in the levels of these neuropeptides in gingival crevicular fluid after removal of the pulp from the painful teeth. Gingival crevicular fluid was collected at baseline from one interproximal site at a painful and a non-painful contralateral tooth from 54 adult patients. Sampling was repeated after 1 wk in a subset of 21 subjects. Samples were analysed for SP, NKA, and CGRP using radioimmunoassay. The mean levels of SP and NKA were significantly higher in gingival crevicular fluid from painful teeth compared with non-painful teeth. The level of SP in the GCF of painful teeth fell significantly 1 wk after pulpectomy. In contralateral teeth, there were no significant differences in the levels of SP and NKA after 1 wk. It is concluded that SP and NKA are present in significantly greater amounts in the GCF of painful teeth compared with healthy teeth.

Neuropeptides and Neurogenic Mechanisms in Oral and Periodontal Inflammation

“…Moreover, recent work in our laboratory indicates that increased tachykinin levels in painful human dental pulp are associated with increased tachykinin levels in the GCF of painful and adjacent teeth (Awawdeh et al, 2002b). It is possible that the increased levels of pulpal tachykinins are mirrored by an increase in activity of fibers in the periodontium, leading to higher concentrations of neuropeptides in GCF.…”

Painful Tooth Stimulation Elevates Matrix Metalloproteinase-8 Levels Locally in Human Gingival Crevicular Fluid

“…This process can release inflammatory mediators from the peripheral nerve terminals, and is thus called 'axon reflex-mediated neurogenic inflammation' (Holzer, 1988). Interestingly, such neurogenic mechanisms may be responsible not only for pulpal-pain-induced blood flow elevations in gingiva (Kemppainen et al, 2003), but also for neuropeptide level elevations in gingival crevicular fluid (GCF) (Awawdeh et al, 2002a).…”

Matrix metalloproteinase-8 and substance P levels in root canal exudates of nonvital teeth

“…그 중 MMP-8은 교원질 분해효소(collagenase)로서 주로 다형핵백혈구에서 분비되는 것으로 생각되었으나 최 근 들어서는 치수세포 및 plasma cell 등에서도 분비되는 것으로 알려졌으며 5,6 치수의 염증이 있을 때 치은 열구액에 서 분비가 증가하는 것으로 보고되고 있다. 7,8 Avellan 등의 연구에 의하면 정상적인 치아에 전기치수자 극을 가했을 때, 즉 통증을 유발하게 되면, 해당치아의 치은 열구액에서 MMP-8과 substance P (SP)의 수준이 높게 검출되었음을 보고하였다. 이들은 전기치수자극에 의해서 신경섬유가 자극을 받고 이로부터 neuropeptide가 분비되 며 이는 직, 간접적으로 MMP-8의 분비를 증진시키는 것으 로 추론하였다.…”

“…7 Awawdeh 등도 치수염으로 통증이 있는 치아에서 치수를 제거하기 전과 치수절제술을 시행한 후 1 주일이 경과했을 때 치은 열구액을 통해서 검출되는 neuropeptides의 양을 비교했을 때 통증이 있는 경우 SP, neurokinin A (NKA), calcitonin gene-related peptide (CGRP)가 유의성 있게 높은 수준으로 나타났음을 보고하 였다. 8 Wahlgren 등은 치수 및 치근단 병소가 있는 치아에서 근 관 치료 과정에서 근관 내의 삼출액을 채취하여 MMP-8의 수준을 연구하였는데 근관치료를 시작하기 전에 유의성 있 게 높다가 근관치료를 진행하면서 MMP-8이 급격히 감소 함을 보고하였다. …”