Understanding pulpal pain

The understanding of the inflammatory, pain and healing processes is of great importance in the practice of dentistry. While bacterial byproducts or immunological agents arising from host inflammatory cells play a major role in pulpal pathosis, the release of neuropeptides from peripheral sensory nerve endings has also been suggested to contribute to pulpal inflammation and pain. The latter process has been termed neurogenic inflammation and has been suggested as an important component in the development of early periapical lesions. Pulpal pain has been widely researched yet there are a number of pain conditions not well understood. Examples are: 1) Symptomatic pulpitis, 2) Post-extirpation pain, 3) Individual variability of dental pain, and 4) Difficulty anesthetizing acutely inflamed pulp. This article reviews the current literature with more focus on neurogenic inflammation in an attempt to offer newer and clearer explanations for pulpal pain conditions