APPENDIX

TABLE AI. Classification of Peripheral Nerve Fibers

Fiber type

Roman numeral

designation

II

III

IV

Greek letter

designation

Aa

A{3

Ay

A8

B C

Diameter (IL)

12-21

6-12

2-8 1-6

1-3 0.4-1.2

Conduction velocity (MIS)

70-120

35-70

12-48 2.5-35

2.5-15 0.7-1.5

409

Source

Muscle spindles Golgi tendon organs Motomeuron axons to muscle Muscle spindles Low-threshold mechanoreceptors Motomeuron axons to spindles Low-threshold mechanoreeeptors Thennoreeeptors Noeiceptors Preganglionic autonomies Low-threshold mechanoreceptors Thennoreeeptors Nocieeptors

410 APPENDIX

FIGURE A 1. Schematic diagrams of different types of intraepithelial endings in skin. (A) Cold receptor and various mechanoreceptors in the glabrous skin of the cat's nose. The cold receptor (cld) is located in the top of the dermal papilla and its terminals penetrate into the basal hiyer of the epidermis. Merkel cell-neurite complexes (m) are sometimes located in the base of an epidermal columnar ridge (cr). Lamellated receptors (Ie) are present in the connective tissue (from Hensel et ai., 1974). (B) Higher magnification of cold receptors. The receptive endings (axr) contain mitochondria and penetrate the basal membrane (bme) of the epidermis, where they lose their Schwann-cell covering (sz). The A-delta afferents lose their myelin sheath (ms) earlier (from Hensel, 1973). (C) Merkel cell-neurite complex. The myelinated axon (A) loses its myelin sheath and becomes associated with the Merkel cell, which contains a multilobulated nucleus (N), Golgi apparatus (GO), desmosomes (D), glycogen (GY), and cytoplasmic processes (P). The nerve terminal (NP) contains mitochondria, and there may be a junctional complex associated with the secretory granules (G) in the Merkel cell (from Iggo and Muir, 1969). (D) Free penicillate endings in the human skin. A terminal Schwann cell (T.Sch.) gives rise to a Schwann sheath (Sch), which envelops nonmyelinated sensory axons along their preterminal course. The endings termi­nate either in the subepidermal zone of the corium (Sub) or intraepidermally (Int), where they lose their Schwann-cell sheath (from Cauna, 1973).

P1 .. kf ./.... . . .

<:.h"· -...:--

412 APPENDIX

FIGURE AI. continued

APPENDIX 413

FIGURE A2. Schematic diagrams of different types of subepithelial endings in skin . (A) Schema of a Meissner corpuscle with the coiled receptor axon (ra) following a tortuous course through the Schwann­cell lamellae (SC). The perineural sheath (pn) and the myelinated axons (ax) are also shown (from Andres and Von Diiring , 1973). (B) Segment of a Golgi-Mazzoni corpuscle in the hairy skin of the cat. Note the perineural sheath (pn) and the concentric sheath of lamellar cells surrounding the terminal axon (ax), which contains numerous mitochondria. The arrow indicates a terminal of an unmyelinated axon apparently synapsing on the axon terminal (from Andres and von Diiring , 1973). (C) Camera lucida drawing of a Ruffini ending. Free nerve ending (a); terminal expansion (b); capillary (c); myelin sheath (d); myelinated axon (0; (from Gardner , 1944). (D) Golgi tendon organ . The myelinated axon (star) is seen entering the capsule lumen . Unmyelinated axons (a) weave in between longitudinal arrays of loosely packed collagen on the right and in the center. Capsule (c); muscle tendon (t) (from Schoultz and Swett, 1974). (E) Straight lanceolate ending on a common hair. The neurite is flattened and cupped between two flattened expanses of Schwann-cell cytoplasm. The sensory neurite (shown also in trans­verse section) contains numerous mitochondria (from Munger, 1971). (F) Transverse section through straight lanceolate endings that form a palisade that is oriented with their long axes parallel with the hair shaft (upper arrows). The axon terminal contains mitochondria and is sandwiched between Schwann-cell cytoplasm (SC); corium of hair follicle (C). The arrows also indicate the probable direction of the effective mechanical stimulus (from Andres and von Diiring, 1973).

c

d--UXI

FIGURE A2. continued

FIGURE A2. continued

416

Hypog lossal nucleus IN. X I II

o I ENCEPHALON (THALAMUS. etc.)

APPENDIX

",,-Mesencephalic nucleus of N. V

Main (Chien sensory nucleus of N. V

..... ·Nucleus of spinal Irad of . V subnucleus oralis I I I subnucleus in terpolaris ( 2 ) subnucleus caudalis f 3 I

." ..... Nuclear gray associated with fasciculus solitarius INn. X.IX. VIII

FIGURE A3. Sensory and motor nuclei of the brain stem associated with cranial nerves (Nn) V, VII, IX, X, XI, and XII. The nuclei occur bilaterally, but for ease of depiction the sensory nuclei are shown on the right , the motor nuclei on the left.

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Index

Acupuncture, 13, 51 , 136 Antidromic activation, 252, 286, 297 Anxiety, 10 Aspirin, 49 Atypical facial neuralgia, 40 Audio analgesia, 50, 136 Autonomic nervous system effects, 122,

385, 393 airway intubation, 407 aspiration reflex, 406 dive reflex, 406 effect on sensation, 402 higher nervous function, 404 referred pain, 402 reflex sympathetic dystrophies, 402 somatic effects, 405 somatic reflexes, 404 sympathectomy, 385 temporomandibular joint pain syndrome,

47 tooth pain, 403 trigeminal neuralgia, 402

Biofeedback, 266, 481 Bradykinin, 9, 23 Brain-stem neural activity

periodontal input, 156 solitary tract neurons, 195, 198 tooth pulp input, 130, 133

Buccinator muscle, 321 Bruxism, 266, 290, 341-345

central regulation, 344 dental factors, 343 emotional stress, 342 etiology, 342 incidence, 341 occlusal interferences, 343 pain, 342 role of suggestion, 343

477

Bruxism (cont.)

signs and symptoms, 341 sleep state, 344 treatment, 344

Carbamazepine, 131, 136 in trigeminal neuralgia, 40

Central pattern generators, 5, 322, 325, 330 Cere bral cortex

barrels, 99 columnar organization, 98 corticofugal effects, 31, 95, 157,266 mechanoreceptive pathways, 97 nociceptive pathways, 37 periodontal input, 157 pharyngeal and laryngeal input, 197,204 reflex regulation, 264, 266, 273, 289, 303 su bmodality specificity, 98 thermal pathways, 71 tooth pulp input, 138

Chewing efficiency, 340 Chronic pain

atypical facial neuralgia, 40 causalgia, 36 congenital insensitivity to pain, 40 glossopharyngeal neuralgia, 40 headache, 41 post herpetic neuralgia, 23, 40 temporomandibular joil\t pain. See

Temporomandibular joint pain dysfunction syndrome

tic douloureux. See Trigeminal neuralgia trigeminal neuralgia, 38, 136, 402

Command neurons. See Central pattern generators

Cornea, 84, 85 Coughing, 372

aspiration reflex, 373 expiration reflex, 373

478

Deciduous teeth, 123 Dentine

autonomic innervation, 122 development, 388 displacement of tubular contents, 127 innervation, 118, 120 odontoblastic activity, 388 trophic effects, 388

Dentures, 106, 159 Development of reflexes, 247, 268, 281,

291,312 Diazepam, 14,49 Digastric muscle, 321 Diphenylhydantoin, 131 Dorsal column-medial lemniscus pathway, 37 Dorsal column nuclei, 2 Drooling, 363

Electroanalgesia of tooth, 143 Electromyogram, 220

interpretation, 221 methods, 220 uses and limitations, 221

Endorphins, 52 Enkephalin, 34, 52 Epileptiform discharges

in neuralgias, 39 Escape behavior, 15, 16 Experimental pain, II Extensor muscles, 4

Face neurotrophic effects, 386 receptors, 83 vasomotor control, 398

Facial motorneurons antidromic activation, 286 excitatory potentials, 285 inhibitory potentials, 288 intracellular recordings, 286, 289

Facial motor nucleus anatomy, 281, 282 somatotopy, 281

Facial reflexes cerebral cortex influence, 289 development, 281 effective stimuli, 283, 284 excitatory periods, 287, 288, 305 inhibitory periods, 287, 288, 305 long-loop reflexes, 288 modulation of, 289, 290 pathways involved, 283, 286, 306

Facial reflexes (cont.) reflex initiation, 283 sleep state, 289

Feedback from teeth, 338-340 force and direction, 338 period of repetitive contacts, 339 receptor sensitivity, 339

First pain, 20, 26 Flexor muscles, 4 Fourth ventricle, I Free nerve endings, 17, 76

Gagging, 370

INDEX

Gamma (fusimotor) efferents, 223, 254, 262 alpha-gamma coactivation, 232, 262 gamma leading, 232 role in modulating spindle discharge, 230

Gate-control theory of pain, 24, 25, 34 Golgi tendon organs, 4, 78, 233, 332

Headache, 41 Hyperalgesia, 23, 24

bradykinin, 23 prostaglandins, 23 relationship to nociceptors, 23

Hypnosis, 51, 344 Hypoglossal motorneurons

antidromic activation, 297 intracellular recording, 297, 299

Hypoglossal nucleus anatomy, 291 somatotopy, 291

Information transmission, 90, 155 Inhibitory mechanisms, 24, 30, 259

afferent inhibition, 92, 200 descending inhibition, 33 postsynaptic, 33, 93, 95, 259, 297, 299 presynaptic, 31, 33, 93, 95, 134, 202, 260,

301, 303, 357 Interdental size

perception of, 170 Interneurons

in reflexes, 305 Intracellular recording, 126, 253, 269, 286,

289, 297, 299

law-closing motorneurons antidromic activation, 252 excitatory potentials, 253, 265, 266

INDEX

jaw-closing motorneurons (cont.) gamma motorneurons, 254, 262 inhibitory potentials, 259, 260, 265, 266 intracellular recording, 253 silent period, 254, 256 silent period in mandibular dysfunction,

263 tonic firing, 254

jaw-closing reflex, 248 cerebral cortex influences, 264 excitatory periods, 258- 262, 305 long-loop reflexes, 264 masseteric reflex, 251, 258, 260 modulation of, 267 monosynaptic, 248 phasic component, 248 reflex initiation, 249 role of supratrigeminal nucleus, 259, 305 silent or inhibitory period, 256, 258, 261,

262, 305 in sleep, 265 tonic component, 249

Jaw-opening reflex cerebral cortex influence, 273 development, 268 effective stimuli, 271 excitatory periods, 272, 305 inhibitory periods, 272, 305 intracellular recordings, 269 as a measure of pain, 14 modulation of, 273, 274 pathways involved, 269, 305 reflex initiation, 269 role of nucleus caudalis, 268, 269 silent period, 268 sleep state, 273

Laryngeal receptors chemosensitive units, 192, 193 flow units, 194 proprioceptive units, 190 tactile units, 191 water units, 191 , 192

Laryngeal sensations pain, 204 tactile, 204

Larynx innervation, 180 input to brain stem, 195-204 laryngeal afferent activity, 189-195 peripheral nerves, 184-188 receptors, 176, 181-183 vasomotor control, 400

Lateral jaw reflexes active guidance, 276 cuspid guided occlusion, 278, 279 effective stimuli, 276 emotional stress, 280 malocclusion, 280 occlusal interferences, 276, 279 passive guidance, 276 role in pain, 279 in temporomandibular joint pain

dysfunction, 280 Lateral pterygoid muscle, 320 Long-loop reflexes, 264, 288

479

Malocclusion, 276, 279, 280, 295, 301, 305, 333, 343

Mandibular rest position, 214 perception of, 168 reflex determinants, 215

Masseter muscle, 320 Mastication

associated muscle activities, 317, 319 central pattern generator, 322, 325, 330 central neural correlates, 321 central regulation, 328, 333 cyclic activity, 323, 325 effective stimuli, 323, 329, 330 feedback from teeth, 338-340 learning, 313 , 326, 334 masticatory movements, 315 ontogeny, 312 peripheral modulation, 329, 331-333 phylogeny, 312 role of cerebral cortex, 326, 328 role of feed back loops, 328, 331 silent period, 318 suckling, 313, 326 tooth contact patterns, 318, 335, 336

Masticatory forces, 337 Masticatory muscles, 320 Mechanoreceptive afferents

conduction velocity, 18, 80-82 cornea, 84, 85 facial skin, 83 field receptors, 81 hair receptors, 81 oral mucosa, 84 position detectors, 75, 80, 86 receptor morphology, 76-78 response to cooling, 69 "transient" detectors, 83 velocity detectors, 75 vibrissal afferents, 86

480

Medial pterygoid muscle, 320 Mesencephalic nucleus, 3, 236

electrotonic junctions, 249 in mastication, 333 muscle spindle afferents, 236 periodontal afferents, 236 in reflexes, 251, 275, 303 structure, 238 synaptology, 238

Monobloc therapy, 266, 295 Motorneurons

alpha, 4 gamma, 4, 233 jaw-closing, 247 jaw-opening, 247

Motor unit, 217 innervation ratio, 218 recruitment order, 219

Multisynaptic pathways, 24 Muscle

biting forces, 213 contractile and histochemical properties,

216 contractile and viscoelastic properties, 214 fibers, 213 length-tension curve, 214 neurotrophism, 382 sarcomere, 213 tension, 213

Muscle afferent paths, 235-240 to cerebellum, 242 to cerebral cortex, 241 .

Muscle receptors, 234 See a/so Muscle spindle; Golgi tendon organ

Muscle spindle function, 227-230 gamma efferents, 223, 230, 232 innervation, 223 role in mastication, 332 structure and distribution, 222, 225

Mylohyoid muscle, 321 Myoepithelial cells, 393 Myofunctional therapy, 363

Narcotic analgesics, 34,49,50, 131, 137, 139 N eurotrophism

dentine, 122, 388 experimental techniques, 381, 383 face, 386 in familial dysautonomia, 385 limb regeneration, 381 muscle atrophy, 382 muscle disuse, 382

Neurotrophism (cont.) muscle receptors, 383 neurotrophic agents, 381

INDEX

role of autonomic nervous system, 385 role of nerve impulse, 383 salivary glands, 385 skin and mucosa, 389 taste buds, 383

Nitrous oxide, 13, 49 Nociceptive afferents

chemical mediators of receptors, 23 classes of, 19, 28 conduction velocity of, 18 receptor morphology, 76 sensitization of, 23, 69

Nucleus ambiguus, 366

Occlusion, 278, 279, 343 Odontoblast, 118, 120

bioelectric potentials, 126 neurotrophic function, 122 streaming potentials, 126 transducer mechanism, 125

Open bite, 362 Opiates

narcotic analgesics, 34, 49, 50, 131, 137, 139 natural or endogenous, 34

Oral mucosa receptor types, 84 vasomotor control, 399

Orbicularis oris, 321

Pain assessment in animals, 14-16 assessment with ratio scales, 13, 14 in bruxism, 342 category rating scales of, 13 chronic. See Chronic pain descending control mechanisms, 31, 34 effect of aspirin, 49 experimental pain stimuli, II from hyperactive reflexes, 280 measurement, 11-16 pain control methods, 49-52 from periodontium, 160 from pharynx and larynx, 204 prostaglandins, 49 referred pain, 23, 41, 402 role of anxiety, 10 role of attitudinal and cognitive

varia bles, 10 role of motivation-affect, 10, 25, 36

INDEX

Pain (cont .)

stimuli,9, 12 from teeth. See Tooth pain from temporomandibular joint, 166 theories of pain mechanisms, 17-25 threshold, 12 tolerance, 12 trigeminal pathways of, 26-38 verbal reports of, II , 14

Periaqueductal gray, 34, 131, 137 Periodontium

adequate stimuli, 154 conduction velocity of periodontal

afferents, 151 distribution of receptors, 152 effect of dentures on thresholds, 159 innervation, 148, 152 input to brain-stem neurons, 156 in mastication, 329, 331 oral stereognosis, 159 pain, 160 periodontal afferents , 87 periosteum, 152 receptor morphology, 150 role in jaw-closing reflex, 250 role in silent period, 3, 153 sensory thresholds, 153, 158 stimulus localization, 158 vasomotor control, 399

Peripheral nerves, 17 Pharyngeal sensations

chemical, 102 pain, 204 tactile, 204

Pharynx cortical projections, 197 innervation, 178 input to brain-stem, 195-204 peripheral nerves, 184-188 pharyngeal afferent activity, 189-190 pharyngeal plexus, 178, 179, 185 receptors, 179 thalamic projections, 197 vasomotor control, 400

Post herpetic neuralgia, 23, 40 Presynaptic hyperpolarization, 94 Prostaglandins, 23, 49

Referred pain, 23, 41, 402 Retching, 370 Reticular formation, 3, 25, 36, 92, 131, 267,

273, 289 Roller's nucleus, 307

Salivary glands excitation-secretion coupling, 394 functional hyperemia, 395 gland enlargement, 386 hypersecretion, 396 hyposecretion, 396 innervation, 391, 394 myoepithelial cells, 393 nerve pathways, 392 nerve transmitters, 393 neurotrophic effects, 385

Second pain, 20, 26 Sensation

autonomic effects on, 402 Silent period, 3, 153, 254, 256, 258,

261-263 , 268, 305, 318 Sinus hairs. See Vibrissae Sleep, 265, 273, 289, 295, 344 Solitary tract nucleus, 198

adequate stimulus, 199 afferent inhibition, 200, 201 convergence, 199 cortical projection, 204 discharge characteristics, 199 extranuclear effects, 202 presynaptic mechanisms, 202 somatotopy, 199 thalamic projections, 203 tuning curves, 200

Specificity theory of pain, 17-23 Speech, 85 Spinal cord

dorsal horn, 2, 25, 70 substantia gelatinosa layer, 25

S pinal nerves

481

differences from cranial nerves, 56, 263, 304 Spinocervical system, 37 Spinothalamic tract neurons

role in pain, 2, 25, 30, 36 Stimulation-produced analgesia, 34, 137

periaqueductal gray, 34, 131 relationship to narcotic analgesics, 34, 137 reversal by naloxone, 137

Stress, 280, 342 Substance P, 34, 123, 127, 131 Sucking, 369 Suckling, 313, 326, 369 Sudden infant death syndrome, 268 Supratrigeminal nucleus, 259, 306, 307 Swallowing

adult swallow, 354 alimentary and respiratory function,

348, 351 anterior open bite, 362

482

Swallowing (cont.) central regulation, 356, 358, 359 cortical initiation, 358 drooling, 363 elementary reflexes, 360, 365 facultative muscles, 353, 354 infantile swallow, 354 initiation of, 349, 350 learning, 356, 360, 364 laryngectomy, 364 muscle equilibration theory, 362 muscle patterns and movements, 351-354 myofunctionaltherapy, 363 nucleus ambiguus, 366 peripheral modulation, 359 pharyngeal pouches, 364 preferential coding, 357 presynaptic depolarization, 357 protective reflex, 348 receptors of origin, 350 reflexogenic areas, 349 related reflex activity, 365-369 requirements, 352 respiratory modulation, 367 swallowing center, 355 tongue and lip forces, 362 tongue-thrust in, 295, 354, 363 tooth contacts, 361 tooth forces, 361, 363

Sweat glands, 396 adequate stimuli, 397 face and neck, 396 gustatory sweating, 397 innervation, 396

Sympathectomy, 385 Sympathetic nervous system

influence on sensory receptors, 5, 117 role in pain, 36,47

Synaptic transmission mechanisms, 31-33

Tactile sensations from vibrissae, 74, 78 in speech, 85 tickle, 75, 83 vibratory, 75, 83

Taste central nervous system "taste" neurons, 104 dentures, 106 effect of age, 106 effect of local anesthetics, 105 effect of noxious stimulation, 105 effect of oral hygiene, 106 effect of tactile stimulation, 105

Taste (cont.) effect of thermal stimulation, 104 innervation of taste buds, 103 neurotrophism, 383 sensitivity of taste units, 103, 104 taste bud location, 102 taste modalities, 102

Temporalis muscle, 320 Temporomandibular joint

effects of overclosure, 168 innervation, 160, 162-164 input to central neurons, 165 location of receptors, 160 in mastication, 332 oral stereognosis, 172 pain sensations, 43-48, 166 primary afferents, 165 receptors, 149, 154, 160, 161-164

INDEX

role in interdental size thresholds and discrimination, 169

role in mandibular position sense, 167 Temporomandibular joint pain dysfunction

syndrome, 3, 43-48 etiology, 44-46 hyperactive reflexes, 280, 305, 308 role of sympathetic nervous system, 47 silent period, 263 treatment, 48

Thalamus effect of morphine, 137 mechanoreceptive pathways, 96 nociceptive pathways, 36-38 periodontal input, 157 pharyngeal and laryngeal input, 197, 203 somatotopy, 96 thermal pathways, 70, 71 tooth pulp input, 137 vibrissae input, 96

Thermal sensations adaptation, 58 effect of adapting temperature, 60 effect of area of stimulation, 65 effect of previous stimuli, 68 effect of rate of temperature change, 64 "paradoxical" cold, 69 persistent cold and warm, 59 reaction times to thermal stimuli, 63, 68 sensory scales of thermal intensity, 62, 65 spatial summation, 65, 66

Thermoreceptive afferents "cold" fibers, 59, 60, 62 conduction velocity of, 18 "paradoxical" cold response, 57 receptor morphology, 57, 76

INDEX

Thermoreceptive afferents (cont.) sensitization of, 69 "warm" fibers, 22, 59, 61, 68

Tongue reflexes cerebral cortex influence, 303 development, 291 effective stimuli, 292-294, 298 excitatory periods, 297, 300, 305 extrinsic muscles, 291 inhibitory periods, 297, 300, 301, 305 intrinsic muscles, 291 in malocclusion, 295, 30 I monobloc therapy, 295 pathways involved, 297, 300, 306 reflex initiation, 292, 297 sleep state, 295 tongue-thrusting, 300, 302 in tongue-thrust swallowing, 295

Tongue-thrusting, 295, 354, 363 Tooth pain

chemical stimuli, 129 diagnostic use, 139 hydrodynamic theory, 127 non pain sensations, 143 pulp vitality, 141 quality, 140, 143 role of cerebral cortex, 138 role of dentine, 118, 124 role of thalamus, 137 role of trigeminal brain-stem nuclei, 133 stimulus localization, 139 sympathetic facilitation, 403 thermal stimuli, 130

Tooth pulp acetylcholine, 125 chemical stimulation, 116, 129 dentinal tubules, 2, 118, 120, 122, 127 development, 110 electrical stimulation, 14, 113, 124, 126,141 electroanalgesia, 143 innervation, 2, 110, 112 intracellular membrane potentials, 126 intrapulpal pressure, 117 mechanical stimulation, 113 microcirculation, 117 as a noxious stimulus, II odontoblasts, 2, 118, 120, 125 receptor morphology, 112 specialized junctions, 2, 118 specificity of pulpal afferents, 115 subodontoblastic plexus, III thermal stimulation, 114, ll7, 124, 129 vasomotor control, 400 vitality, 141

Trigeminal brain-stem nuclei descending modulation, 95 information transmission, 90 input from vibrissae, 90 main sensory nucleus, 2, 87, 94 mechanoreceptive neurons, 88-90 mesencephalic nucleus, 3, 236, 275

483

nucleus caudalis. See Trigeminal nucleus caudal is

nucleus interpolaris, 88 nucleus oral is, 2, 87 periodontal representation, 156 pulp and periodontal convergence, 156 tooth pulp representation, 131 tractotomy procedure, 26, 35, 69, 132, 136

Trigeminal motor nucleus anatomy, 247 development of reflexes, 247 somatotopy, 247

Trigeminal nerve development of, I pharyngeal branches, 178 ratio of myelinated to unmyelinated fibers,

2, 26, 56 Trigeminal neuralgia, 38, 136, 402 Trigeminal nucleus caudalis

comparison to spinal cord, 94 functional properties of neurons, 28,29, 87 marginal layer, 28, 35, 70 modulatory role, 136, 156 role in jaw-opening reflex, 268, 269 role in pain mechanisms, 27, 34 role in thermal sensations, 70, 92 role in tongue reflexes, 30 I somatotopy, 88 substantia gelatinosa layer, 28, 35 tooth pulp representation, 131

Trigeminothalamic neurons, 28

Unloading reflex, 274 mesencephalic nucleus, 275

Vasomotor control, 398 facial skin, 398 gingiva, 399 oral mucosa, 399 periodontium, 399 pharynx and larynx, 400 tooth pulp, 400

Vibrissae, 74, 78, 90, 96 Vomiting, 370