Effect of Experimental Periodontal Ligament Pain on Gingival Somatosensory Sensitivity

Aims: To use a randomized, blinded, crossover design to evaluate the possible heterotopic effects of experimental periodontal ligament pain on adjacent gingival somatosensory sensitivity. Methods: A total of 12 healthy volunteers (8 female, 4 male; mean age ± standard error in means (SEM): 28 ± 1 years) participated in two randomized experimental quantitative sensory testing (QST) sessions, one in which capsaicin (experimental) was injected into the periodontal ligament and one in which isotonic saline (control) was injected. A total of 13 standardized QST measures were obtained on the buccal attached gingiva of a maxillary central incisor before, immediately after, and 30 minutes after injection of 30 μL of 5% capsaicin or isotonic saline into the periodontal ligament of the same incisor. The injection-evoked pain was evaluated on a 0-10 numeric rating scale (NRS). QST data were analyzed with two-way repeated measurement analysis of variance. Results: Capsaicin injected into the periodontal ligament evoked moderate levels of pain (mean peak NRS ± SEM: capsaicin: 5.5 ± .7; control: 0.6 ± 0.5 [P .001]). Capsaicin injected into the periodontal ligament significantly modulated gingival somatosensory sensitivity: increased sensitivity to warmth and painful heat stimuli occurred immediately and 30 minutes after the injection (P .025), whereas decreased sensitivity to both tactile and painful mechanical stimuli (P .011) occurred immediately after the injection and to painful mechanical stimuli only after 30 minutes (P = .016). No somatosensory changes were detected following the injection of isotonic saline (P > .050). Conclusion: Capsaicin injected into the periodontal ligament caused gain of heterotopic somatosensory sensitivity toward warmth and painful heat stimuli as well as reduction in mechanical sensitivity of the gingiva adjacent to the injected tooth. These findings may have implications for interpretation of somatosensory functions in patients with chronic intraoral pain, where gingival somatosensory profiles similar to those detected after capsaicin injection in the present study may be interpreted as signs of nerve damage. Keywords: capsaicin, intraoral QST, pain mechanisms, periodontal ligament, somatosensory