How to better Identify The Tooth That Aches


With regards to a toothache, the mind doesn’t discriminate. A new imaging study demonstrates that to the brain, a painful upper tooth feels a lot like an agonizing lower tooth. The outcomes, which will probably be published within the journal Pain, help clarify why patients are notoriously poor at pinpointing a toothache.

For the most component, humans are exquisitely tuned to discomfort. The brain can instantly distinguish in between a splinter within the index finger along with a paper cut on the thumb, even though the digits are next-door neighbors. But within the mouth this can be more challenging, depending exactly where and how intense the ache is.

“We don’t know a lot about tooth discomfort,” comments dentist and neuroscientist Alexandre DaSilva of the University of Michigan in Ann Arbor, who was not part of the new research. The new study is among the first to address the puzzle of toothache localization, he says.

Within the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in wholesome – and brave – volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy 1) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation comparable to that felt when biting into an ice cube, Forster says, and were tuned such that the topic always rated the discomfort to be about 60 percent, with 100 percent becoming the worst discomfort imaginable.

To see how the brain responds to discomfort emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. “At the beginning, we expected a good difference, but that was not the case,” Forster says.

Many brain regions responded to top and bottom tooth discomfort – carried by signals from two distinct branches of a fiber called the trigeminal nerve – in the same way. The V2 branch carries pain signals from the upper jaw, and also the V3 branch carries discomfort signals from the lower jaw.

In particular, the researchers found that regions in the cerebral cortex, including the somatosensory cortex, the insular cortex and the cingulate cortex, all behaved similarly for each toothaches. These brain regions are recognized to play important roles in the discomfort projection system, but none showed major differences in between the two toothaches. “The activation was much more or less the same,” Forster says, even though he adds that their experiments may have missed subtle differences that could account for why some tooth pain could be localized.

Because the exact same regions were active in each toothaches, the brain – and also the person – couldn’t tell where the discomfort was coming from. “Dentists should be aware that patients are not always able to locate the pain,” Forster says. “There are physiological and anatomical reasons for that.”

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