The localisation of Experimentally Evoked Dental Pain: an exploration of an intervention to improve the accuracy of localisation

  • Nuha Ashaibi

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Background: The accurate localisation of the symptomatic tooth with pulpal pain could be very difficult for the dental patient and a challenging situation for the dentists. Objectives: This study aimed to determine the localisation accuracy of induced dental pain under a highly controlled experimental conditions and to modulate this pain to improve localisation accuracy by applying remote noxious conditioning stimuli.

    Methods: Four principal, related but discrete studies were conducted in this investigation. The experiments were carried out on human volunteer participants (aged 18 to 33 years). All were healthy and dentate. Maxillary teeth were stimulated using the following procedures in all of the studies: electrical stimuli were delivered to teeth through customised bipolar electrodes in a random order. The first study was carried out on anterior and posterior teeth at the pain threshold (T), and supra-pain threshold (1.25T). The following studies were carried out on anterior teeth only at supra-pain threshold (1.25T) while the effect of three different conditions were investigate: remote noxious stimuli i) immersion of the hand in a cold water bath at 3°C, ii) applying acupressure using a Pressure Stimulating Device (PSD) on LI4 acupoint on the hand and iii) manual application of acupressure on LI4 acupoint. The percentage success rate was recorded with and without the remote noxious conditioning stimuli and compared statistically.

    Results: The percentage success rates of the accuracy of localisation for anterior and posterior teeth were found to be 42% and 66% respectively, with no statistical significant differences between them (Friedman`s Two-Way ANOVA ).The application of remote noxious conditioning stimuli improved the ability to localise the tooth stimulus in anterior teeth. in some cases - i) Immersion of the hand in cold water bath improved the accuracy of localisation significantly from 33% to 66% (P<0.008, Wilcoxon Signed-Rank Test) ii) acupressure manipulation with PSD also significantly improved localisation from 33% to 55% (P<0.009, Wilcoxon Signed-Rank Test). Whereas, manual acupressure improved the accuracy of localisation from 22% to 50% but not to a statistically significant extent.

    Conclusions: It is concluded that the dental pain of pulpal origin in maxillary anterior and posterior teeth was difficult to always locate accurately. The application of remote noxious conditioning stimuli improved the accuracy of localisation of pulpal pain. This may be due to activation of Diffuse Noxious Inhibitory Control (DNIC) mechanism.
    Date of Award2020
    Original languageEnglish
    SupervisorMark Hector (Supervisor), Pauline Maillou (Supervisor) & Andrew Mason (Supervisor)


    • Dental pain

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