Dr.

Tahani Abualteen

Introduction to Oral Physiology

Physiology & oral physiology: General physiology = a branch of biology that deals with the study of functions of living matter Oral physiology = the study of the functions of the mouth and associated structures Why do we need to study oral physiology? 1. Knowledge of normal functions of the mouth leads to 2. Explanation of oro-facial dysfunction (malfunction), therefore 3. Suggesting better methods for diagnosis & treatment For example some people have clicking in their TMJ, and to be able to identify this abnormality, we need first to understand how the TMJ normally behave and function, after that we can perfectly diagnose the patient and treat him 4. Practical example of how knowledge of oral physiology has an impact on industry & marketing is fooling the taste system by diet sweets For example by understanding the way taste sensation happens, industry came with a number of artificial sweeteners that work by fooling the taste system (tasting the sweetness of food and fulfilling the desire for sweets without getting the harmful effect of them, because in those sweeteners glucose or sucrose are not used, fructose is used instead) Functions of the human mouth: Portal (entrance) to GIT o It is a human & animal trait o It guides food intake o It Prepares food for swallowing & digestion Muscles of mastication (which open & close the mandible) play a role Muscles of lips and cheeks (which move the food from one side to another) play a role Muscles of the tongue play a role Interaction (occlusion) of upper & lower jaw teeth play a role Saliva play a role ** Tongue doesnt only taste food, but it can also feel it (e.g. it's texture, it's temperature ) Speech production o It is a human trait only (distinguishes humans from animals) o It requires complicated control of many oral, pharyngeal and laryngeal structures Prehensile (holding objects) o It is more evident in animals than humans (because humans have very skillful hands) Functions of oral cavity are organized: Food analyzed by sensory systems involved in perception of: o Taste o Smell o Touch
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o Temperature o Pain Sensory information is integrated in the brain o Information is about the different characteristics of food (e.g. liquid or solid, hot or cold, salty or sweet ) o As a result: Saliva is secreted from salivary glands to: o Lubricate the food and make mastication easier Chewing movements begin o Mastication requires occlusion (intercation between upper jaw & lower jaw teeth) o Neuromuscular control of muscle movements o Protection from tissue damage ** Neuromuscular control is very important to prevent any accidental injury/biting to tissues and muscles such as the tongue, cheeks, or lips) Swallowing eventually occurs o Once the food is ready (chopped by teeth and lubricated by saliva) its swallowed into the GIT Pain: Dentistry owes its very beginning to the quest for pain relief ** If pain wasnt felt in the mouth, then dentistry wouldn't have emerged ** Thousands of years ago, dentistry was all about pain relief, while nowadays it isnt only concerned about that, but also concerned of improving function & esthetics of teeth Classical foundations of dental profession o Identification of pain o Diagnosis of pain o Elimination of pain Characteristics of pain: o It is a subjective symptom Pain is different from one person to another (same amount of pain is experienced differently among different people according to their sensitivity) o It is a reaction elicited by a stimulus Person in pain, most properly has a cause (stimulus) for this pain o It may involve a tissue damage o It provides a warning to seek treatment Pain = blessing or warning to seek treatment (without pain we wouldnt know if theres a problem in the first place, and so our teeth would be destroyed without us knowing) Pain Threshold = the point beyond which a stimulus causes pain, or the upper limit of tolerance to pain The lower is the pain threshold the better, Why

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In order to feel the pain in the earliest stages of any malfunction and seek the treatment immediately to protect tissues from damage o Pain can be either Acute or chronic Acute pain = pain happening over a short period of time and very intense (severe) Chronic pain = pain happening over a long period of time, less intense (less severe) & comes and goes In case of acute pain, patients would be seeking immediate treatment and thus it is better o Pain is either spontaneous or provoked Provoked (stimulated) pain = pain with a cause Spontaneous pain = pain without a cause o Pain is either continuous or intermittent Continuous pain = pain started and continuing through a period of time without stopping Intermittent pain = pain coming and going through a short period of time ** When time intervals between each episode of pain and the other are short BUT NOT equal intermittent pain ** When time intervals between each episode of pain and the other are short and equal Periodic Intermittent ** When time intervals between each episode of pain and the other are long recurrent pain o Pain can be localized, diffuse, spreading, migrating or referred Localized pain = pain affecting an exact spot so that the patient can easily locate the origin of pain (e.g. upper right 1st molar tooth) Diffuse pain = pain affecting a large area that the patient can't easily locate the origin of pain but instead he can locate the area (e.g. upper right quadrant) Spreading, migrating pain = pain moving to a surrounding area from the origin (different area from the origin) BUT the pain is still felt in the origin Referred pain = pain moving to a distant area from the origin BUT the pain is NOT felt in the origin anymore Definition of pain: o It is a complex series of phenomena o It is an unpleasant emotional & sensory experience associated with actual or potential tissue damage ** When tissues are damages, signaling molecules get released, and initiate pain o It is an abnormal affective state aroused by the pathological activity of a specific sensory system ** Neurons consist of cell body, dendrites, and axons ** Axons can be either Myelinated or Unmyelinated ** Myelinated axons have faster propagation of signals ** Signals move from the dendrites to the nerve terminus ** Synapse = the junction between terminus of one neuron and dendritic process of another neuron
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** Neurotransmitters are released into the synaptic space to function as signaling molecules that initiate and propagate pain or any other sensory of motor impulses ** Dendrites are the site where pain is initiated ** Nerve terminus is the site where pain is transmitted to another neuron by synapsing with its dendrites Pain is NOT simply an excessive stimulation of some other sense such as touch or temperature If any part of the body is stimulated excessively (not necessarily intensely), like for example continually pressing the hand, as long as there's no tissue damage, whatever we are feeling then is NOT pain Pain instead is related to tissue damage at a cellular level This is why physiologists replace pain with noxious & "pain receptors" with nociceptors Noxious & nociceptors are more appropriate terms since they more represent tissue damage Pain stimulants = products of tissue damage that when released, they initiate pain o o o o o o Hydrogen ions Potassium ions Prostaglandins Polypeptides Histamine Serotonin

Aspirin blocks the chemical receptors that are involved in pain sensation by blocking the pathway that leads to the formation of the previous products (especially prostaglandins) Aspirin inhibits an enzyme called cyclo-oxygenase which is important in the process of formation of pain stimulants (e.g. Prostaglandins), and when this happens; pain is lost Aspirin is not used that much because its an anticoagulant (prevents blood coagulation) Safer drugs to use include non-steroidal anti-inflammatory drugs (e.g. Ibuprofen)

Nociceptors: o Touch & temperature receptors are well defined o Nociceptor is a term used to describe a nerve ending that responds to stimuli that actually or potentially produce tissue damage o Pain receptors (nociceptors) respond to painful stimuli o Nociceptors may respond to very gross mechanical stimuli If the mechanical stimulus is very intense and able to produce tissue damage, then nociceptors may respond to it although touch receptors are the one responsible for mechanical stimuli o Other stimuli may result in painful sensation when level of stimulus is increased For example if hand is put in a warm water, then thermal receptors will tell the brain that this water is warm If the stimulus is more intense (the water isn't just warm, it is boiling) then when hand is put, thermal receptors will respond and also nociceptors since some tissue damage was produced o A single noxious heat stimulus is sensed as painful o Repetitive stimulation of temperature receptors with less powerful stimuli may inhibit the passage of pain
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So if you keep stimulating the thermal receptors with less powerful stimuli over a long period of time, passage of pain is inhibited, yet the exact pathway is not well known Gate control theory: o Stimulation of other sensory receptors (e.g. touch, temperature ) at the same time as the nociceptors can prevent the perception of pain o This theory can explain the acupuncture treatment () The gate is open either for touch or pain In the brain we have a common pathway for each one of them at a time, so at first the gate is open for pain, but when certain areas in the body have their touch receptors stimulated repetitively, the gate for pain signals closes and opens for that other impulse o If the impulses in the nociceptive nerves could proceed up to the cortex, pain would be perceived the pain gate would be opened, BUT pain gate would close if other impulse (such as touch) could reach the cerebral cortex before the Nociception o Explains why pressing on a painful area or clenching on a painful tooth relieves the pain A or C fibers: o The nociceptors are of two types A or C fibers o Information originating in nociceptors travels over small diameter afferent nerves (A or C fibers) Afferent = conducts information from a distant place to the brain (sensory) Efferent = conducts information from the brain to a distant tissue (motor or secretory) A or C fibers conduct pain to the brain ,thats why they are afferent (sensory) o Double nature of pain A faster producing stinging pain (sharp of high intensity) initial pain C slower producing agonizing intolerable (diffuse) second pain

For example: suppose you are walking in your home, when suddenly your foot hits something like a table or a chair and it's too painful, what you will actually feel are two types of pain The first (initial) pain is felt due to A fibers because they are the faster ones producing stinging pain (sharp of high intensity) Then the second pain is felt due to C fibers because they are the slower ones producing agonizing intolerable diffuse pain C fibers are Unmyelinated and thus pain impulses travel through them very slowly A fibers: o o o o o o Myelinated (2.5 m) Conducting at 12-30 m/s High threshold to be stimulated, the stimulus has to be very intense and higher than the threshold Transmit information from nociceptors or mechanoreceptors Activated by intense mechanical stimulation Involved with 1st pain Sharp localized sensation from obvious mechanical damage and lasts for less than one second

C fibers: o Non-Myelinated (0.4-1.2 m) smaller than A fibers

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o Conducting at 0.5-2 m/s slower than A fibers o Poly-modal Transmit a number of different stimuli though they are thought to be purely nociceptive in human can't transmit information from mechanoreceptors as A fibers Excited by intense mechanical, thermal & mechanical Diffuse (not sharp) & dull that follows 1st pain May arise independently without a 1st pain before it sometimes stimulation may occur only to the C fibers (if the stimulus is low in intensity)

o Involved with 2nd pain

Pain neuron: o Neuron Cell body and dendritic processes Axon o Neurons conducting pain travel along three levels Primary Secondary Tertiary Cell bodies in - Posterior root ganglia of spinal cord OR - Ganglia of cranial nerves Ganglia = aggregation of cell bodies in the PNS In the cranial area; all primary neurons conduct pain from pain receptor nerve endings to the Spinal Nucleus of Trigeminal nerve irrespective of the cranial nerve of origin From Spinal Nucleus of Trigeminal nerve to thalamus From Thalamus to cerebral cortex

o Primary neuron

o Secondary neuron o Tertiary neuron Factors affecting pain threshold: o Factors lowering threshold so that small stimulus is needed to produce pain sensation Psychological factors Fear & worry Excitement & relaxation Soothing (relaxing) music

o Factors elevating threshold so that intense stimulus is needed to produce pain sensation

Nerve Physiology: Nerve cell axon is the area where pain impulses are conducted and travel Intracellular Fluid (inside the axon) Extracellular Fluid (outside the axon)
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Na and K ions Na and K channels Difference in polarity of interior and exterior of axon Resting Membrane Potential o A result of the relative distribution of Na and K ions across the axon membrane o Intracellularly [K+] is high, [Na+] is low o Extracellularly [Na+] is high, [K+] is low Intracellular charge is now negative relative to extracellular Potential difference of about 60 - 90 mV The natural tendency of Na influx is prevented by Na pump, a process that needs energy No impulses are travelling o At the state of rest

Depolarisation: o Action Potential and Depolarisation: Rapid fall in membrane potential from 70 to +20 - 30 mV Nerve impulse (action potential) propagates along the axon and when it reaches the resting segment of the axon it creates an electrical stimulus which increases the permeability of the diffusion barrier to Na and K ions by opening voltage gated ion channels Na+ ions move into cell while K+ ions move out along concentration gradient (without energy) Intracellular charge is now positive relative to extracellular This segment of the axon has undergone depolarisation and is in a state of action potential As depolarisation progresses along the axon, the action potential is propagated and the nerve stimulus continues down the length of the axon Repolarisation: o The axon returns to its original state with initial concentrations of Na and K ions restored and the interior once again negative relative to the exterior o This is achieved by the Na and K channels o The axon is ready to undergo depolarisation again to propagate a nerve impulse o Active process that takes up energy

Mechanism of action of local anaesthesia: o Blocking of the Na ion pumps in the cell membrane wall o This results in an inability for Na ions influx when the action potential arrives at a given segment of the nerve o No effect on resting potential
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