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Periodontics Supporting Your Practice

The Paradox of Pain in Periodontal Diseases

Dr. Andy Grant accepted my request for an interview although he is not a dentist 🙂 Nevertheless, his interest in studying pain in general coupled with a suggestion made by his colleague, a dentist, brought about two articles related to pain in dentin hypersensitivity and periodontal diseases. He joined from London to tell our viewers more about the findings of the two studies.

I hope you find the interview interesting and that you share your feedback with us through oasisdiscussions@cda-adc.ca 

Chiraz Guessaier, CDA Oasis Manager


TRPA1 and TRPV4 Activation in Human Odontoblasts Stimulates ATP Release

  • The mechanism of pain in dentine hypersensitivity is poorly understood but proposed to result from the activation of dental sensory neurons in response to dentinal fluid movements.
    Odontoblasts have been suggested to contribute to thermal and mechanosensation in the tooth via expression of transient receptor potential (TRP) channels. However, a mechanism by which odontoblasts could modulate neuronal activity has not been demonstrated.
  • In this study, the authors investigated functional TRP channel expression in human odontoblast-like cells and measured ATP release in response to TRP channel activation.
  • Human immortalized dental pulp cells were driven toward an odontoblast phenotype by culture in conditioned media. Functional expression of TRP channels was determined with reverse transcription polymerase chain reaction and ratiometric calcium imaging with Fura-2.
  • ATP release was measured using a luciferin-luciferase assay. Expression of mRNA for TRPA1, TRPV1, and TRPV4 but not TRPM8 was detected in odontoblasts by reverse transcription polymerase chain reaction.
  • Expression of TRPV4 protein was detected by Western blotting and immunocytochemistry. The TRPA1 agonists allyl isothiocyanate and cinnamaldehyde and the TRPV4 agonist GSK1016790A caused a concentration-dependent increase in intracellular Ca2+ concentration that was inhibited by the selective antagonists HC030031, AP18, and HC067047, respectively.
  • In contrast, exposure to the TRPV1 agonist capsaicin or the TRPM8 agonist icilin had no effect on intracellular Ca2+ concentration. Treatment with allyl isothiocyanate, cinnamaldehyde, or GSK1016790A caused an increase in ATP concentration in culture medium that was abolished by preincubation with TRP channel antagonists.
  • These data demonstrate that activation of TRPA1 and TRPV4 channels in human odontoblast-like cells can stimulate ATP release. We were unable to confirm the presence of thermosensitive TRPV1 and TRPM8 that has previously been reported in odontoblasts.

The paradox of painless periodontal disease

  • Periodontal diseases, primarily gingivitis and periodontitis, are characterised by progressive inflammation and tissue destruction. However, they are unusual in that they are not also accompanied by the pain commonly seen in other inflammatory conditions. This suggests that interactions between periodontal bacteria and host cells create a unique environment in which the pro-algesic effects of inflammatory mediators and factors released during tissue damage are directly or indirectly inhibited.
  • In this review, the authors summarise the evidence that periodontal disease is characterised by an accumulation of classically pro-algesic factors from bacteria and host cells. They then discuss several mechanisms by which inflammatory sensitisation of nociceptive fibres could be prevented through inactivation or inhibition of these factors.
  • Further studies are necessary to fully understand the molecular processes underlying the endogenous localised hypoalgesia in human periodontal disease. This knowledge might provide a rational basis to develop future therapeutic interventions, such as host modulation therapies, against a wide variety of other human pain conditions.

Full Interview ( “)



  1. Mark Antosz September 11, 2017

    Don’t forget the role of the occlusion in both the hypersensitivity and as a contributing factor (if not etiologic) in periodontal disease. I’ve seen this in more than a few patients and the pain resolves once they have been stabilized. Could this be the differentiator between those with hypersensitivity and those without?

  2. Andy Grant September 13, 2017

    Hi Mark, thanks for your comment. I think it’s the absence of pain that is fascinating, so even if stabilization does resolve the pain there still isn’t a clear explanation for why the periodontal inflammation doesn’t hurt. A sprained wrist becomes swollen, and hurts when touched gently (mechanical hypersensitivity), but that doesn’t seem to be happening in chronic periodontitis – the swelling / inflammation is there, but not the pain. That has driven our interest in this area.


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