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Questions and Answers
What is the primary role of substance P in the pulp response?
Which neuropeptide is associated with immunosuppressive activity?
What is a consequence of the release of neurogenic mediators in response to external stimulation of dentin?
What effect does calcitonin gene-related peptide (CGRP) have on pulp healing?
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Which process is affected by the stimulation of sympathetic nerves in the pulp?
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What interaction might explain gender differences in dental pain presentation?
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Which of the following mediators is NOT mentioned as a neurogenic mediator associated with pulp responses?
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Which statement best describes the relationship between neurogenic mediators and the immune response in dental pulp?
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Study Notes
Neurogenic Mediators in Pulp Response
- Neurogenic mediators are released from pulp afferent nerves in response to external stimulation of dentin.
- These mediators include Substance P (SP), calcitonin gene-related peptide (CGRP), neurokinin A (NKA), neurokinin Y (NKY), and vasoactive intestinal peptide (VIP).
- Neurogenic mediator release can lead to vasodilatation and increased vascular permeability, resulting in elevated tissue pressure that can cause necrosis in extreme cases.
- Stimulation of sympathetic nerves by mediators like norepinephrine, neuropeptide Y, and ATP can alter pulp blood flow (PBF).
- Inflammation can trigger sprouting of afferent fibers, as demonstrated by receptor field and anatomical studies.
Modulation of the Pulp Immune Response
- SP acts as a chemotactic and stimulatory agent for macrophages and T lymphocytes, leading to increased arachidonic acid metabolites, lymphocytic mitosis, and cytokine production.
- CGRP demonstrates immunosuppressive activity by reducing Class II antigen presentation and lymphocyte proliferation.
- SP and CGRP are mitogenic for pulp and odontoblast-like cells, initiating and promoting pulp healing.
- CGRP stimulates the production of bone morphogenic protein by human pulp cells, potentially inducing tertiary dentinogenesis.
Clinical Implications of Neurogenic Mediators
- SP levels increase in the dental pulp and periodontal ligament after acute occlusal trauma, potentially contributing to pain associated with concussion traumatic injury.
- Gender differences in CGRP production have been observed. For example, serotonin induces a more significant increase in capsaicin-evoked CGRP release in dental pulps from females compared to males.
- This interplay of inflammatory mediators may explain some of the gender differences in clinical presentation of dental pain.
- Neurotropic factors like neurogenic mediators are present in dentin matrix and may be released during regenerative procedures, supporting trigeminal neurite growth.
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