JOURNAL OF ENDODONTICS I VOL 6, NO l, JANUARY 1980

Sensory response to thermal stimulation in human teeth

H e n r y O. T r o w b r i d g e , DDS, PhD; M i c h a e l Franks, BDS;

Edward Korostoff, PhD; and Robert E m l i n g , EdD.

This s t u d y i n v e s t i g a t e d the r e s p o n s e of t e e t h to t h e r m a l s t i m u l a t i o n .
T h e s e n s o r y r e s p o n s e o c c u r r e d b e f o r e the t e m p e r a t u r e w a s c h a n g e d
in the r e g i o n of the p u l p o d e n t i n a l j u n c t i o n w h e r e s e n s o r y s t r u c t u r e s
are located. A t h e o r e t i c a l m o d e l w a s d e v e l o p e d to e x a m i n e the
h y d r o d y n a m i c forces p r o d u c e d b y t e m p e r a t u r e c h a n g e in the dentin.
It is t h e o r i z e d that t h e s e forces m a y be c a p a b l e of exciting s e n s o r y
s t r u c t u r e s in the tooth.

Thermal stimulation has long been
used in clinical dentistry as a means
of determining the vitality of teeth.
Tests with both heat and cold are
used as diagnostic aids to distinguish
between a normal pulp and pulps
that are inflamed or necrotic. In spite
of the common use of these tests,
surprisingly little is known about the
way in which external energy in the
form of heat and cold is converted
into electrical signals by the sensory
structures of the tooth. The anatom-
ical relationships between the odon-
toblasts, their processes, and the
sensory nerve endings have been
shown by several investigators, in-
eluding Frank, 1 Arwill, 2':/ and Cor-
pron and Avery? Unmyelinated
nerve endings (receptors) are situ-
ated among the cell bodies of odon-
toblasts, and some can be traced for
an extremely short distance of up to
80 /~ into the tubules of the inner
dentin. These nerve fibers have been
found to lie in close association with
odontoblast processes. 1 Thus, termi-
nals of receptor neurons of the pulp
are situated in the region of the
pulpodentinal junction (PDJ), and it
seems reasonable to assume that
these receptors are the first sensory
structures to respond to external
thermal stimulation.
Excitation of sensory receptors by
thermal stimulation could occur in
one of two ways. An obvious possibil-
ity is that thermal stimuli are
conducted through the enamel and
dentin and, on reaching the PDJ,
change the temperature of the recep-
tors enough to produce excitability.
In this case, the terminals would be
functioning as thermoreceptors. On
the other hand, if the terminals are
assumed to be mechanoreceptors,
physical forces created by rapid heat-
ing or cooling of the dental tissues
could give rise to mechano-electrical
transduction by distorting the sur-
face membranes of the receptors.
Because the degree and rate of
temperature change occurring at the
P D J during thermal testing has not
been previously reported, the pur-
pose of this study was to examine the
temporal relationships between the
application of heat or cold to teeth,
the evoked sensory response, and
temperature change in the region of
the PDJ.
MATERIALS AND METHODS
Patients were selected whose or-
thodontic plan of treatment called
for the extraction of one or more
premolars. A total of 16 teeth from
eight patients, four boys and four
girls, ranging in age from 9 to 16,
were included in the study.
The heat test consisted of applying
a heated stick of gutta-percha to the
test site, the center of which was the
buccal triangular ridge, midway
between the buccal cusp and the
center of the occlusal surface. T h e
end of the gutta-percha stick was
heated over an alcohol flame until it
became soft and just began to
"smoke," according to the method of
Grossman? Petroleum jelly was ap-
plied as a lubricant to the test site to
prevent the gutta-percha from stick-
ing to the surface of the enamel. A
stop clock was used to record the
elapsed time between application of

: 405

the g u t t a - p e r c h a a n d the p a t i e n t ' s
response. This time p e r i o d will
henceforth be referred to as the
sensory response t i m e ( S R T ) . Pa-
tients were instructed to i n d i c a t e b y
h a n d signal the m o m e n t they per-
ceived sensation. U n h e a t e d gutta-
p e r c h a was a p p l i e d to the tooth
before testing so t h a t the p a t i e n t
could learn to distinguish between
pressure a n d the sensation p r o d u c e d
b y heat.
C o l d testing was c a r r i e d out in a
similar fashion except t h a t the skin
refrigerant c h l o r o e t h a n e (ethyl chlo-
ride) was used as a test agent. A
cotton pellet was s a t u r a t e d to the
p o i n t of d r i p p i n g with liquid chloro-
e t h a n e a n d was a p p l i e d to the test
site with a p a i r of c o t t o n forceps. In
b o t h heat a n d cold testing, the stim-
ulus was removed from the tooth as
soon as a sensory response h a d been
registered by the p a t i e n t .
T o d e t e r m i n e the t e m p e r a t u r e
changes occurring at the P D J d u r i n g
t h e r m a l testing, the following proce-
d u r e was used. After t h e r m a l testing
in the clinic, the teeth were extracted
a n d i m m e d i a t e l y taken to the labora-
tory where the roots were cut off a n d
p u l p s were removed. A t h e r m i s t o r
p r o b e was inserted into the open
p u l p c h a m b e r , a n d the tip of the
p r o b e was positioned so t h a t it rested
on the inner wall of the d e n t i n at a
p o i n t opposite the test site on the
surface of the tooth. C o r r e c t place-
m e n t of the probe was c o n f i r m e d by
radiographs. T h e t h e r m i s t o r was
connected to a t e l e t h e r m o m e t e r that,
in turn, was linked to a p a p e r chart
recorder. T h e p u l p c h a m b e r was
filled with Plastibase ( S q u i b b ) , a sili-
cate c o m p o u n d , to s i m u l a t e the
presence of p u l p tissue. T h e tooth
was w a r m e d in a w a t e r b a t h until the
thermistor registered 34 C, the
406
JOURNAL OF ENDODONTICS I VOL 6, NO 1, JANUARY 1980
a p p r o x i m a t e t e m p e r a t u r e of a vital
pulp. T h e occlusal surface of the
tooth was positioned above the level
of the w a t e r so that the g u t t a - p e r c h a
or c h l o r o e t h a n e could be a p p l i e d to
the test site. T h e t h e r m a l tests t h a t
h a d been c o n d u c t e d in the clinic
then were r e p e a t e d on the t o o t h as
a c c u r a t e l y as possible, a n d a record
was m a d e of the t e m p e r a t u r e
changes occurring at the PDJ.
T h e t e m p e r a t u r e at the t o o t h
surface d u r i n g t h e r m a l testing was
e s t i m a t e d b y the following m e t h o d .
Using a r o u n d b u r t h a t was a p p r o x i -
m a t e l y the same d i a m e t e r as the
t h e r m i s t o r probe, a hole was d r i l l e d
from the p u l p c h a m b e r to the surface
of the t o o t h in the center of the test
site. T h e t h e r m i s t o r p r o b e was
inserted t h r o u g h the hole a n d posi-
tioned so t h a t the tip was flush w i t h
the surface of the enamel. T h e t o o t h
was p l a c e d in the w a t e r b a t h a n d
w a r m e d at 34 C. H e a t e d g u t t a -
percha or chloroethane then was
a p p l i e d to the surface of the t o o t h as
described, a n d recordings were m a d e
of the t e m p e r a t u r e changes.
T h e r a t e a n d a m o u n t of t e m p e r a -
ture c h a n g e at the P D J after the
a p p l i c a t i o n of heat to the test site
was d e t e r m i n e d by using a s t a n d a r d -
ized testing p r o c e d u r e so t h a t the
period of a p p l i c a t i o n could be k e p t
constant. H e a t was a p p l i e d to each
of the test teeth for a period of five
seconds in accordance with the
m e t h o d of t h e r m a l testing a d v o c a t e d
by Cohen. ~
T h e a m o u n t of tooth substance
situated b e t w e e n the test site on the
surface of the tooth a n d the P D J was
ascertained by sectioning each t o o t h
l o n g i t u d i n a l l y a n d m e a s u r i n g the
distance with an optical m i c r o m e -
ter.
RESULTS
T a b l e 1 gives the sensory response
time ( S R T ) for each of the teeth
tested with h e a t a n d cold. T h e m e a n
SRT of all teeth tested was
1.28 _+ 0.38 (SD) seconds when h e a t
was a p p l i e d a n d 1.49 _+ 0.50 (SD)
seconds w h e n cold was used. W h e r e -
as all of the teeth r e s p o n d e d to heat,
two test teeth of one p a t i e n t failed to
respond to the cold test.
W h e n t h e r m a l tests were per-
formed in the l a b o r a t o r y on ex-
tracted teeth, the t e m p e r a t u r e s re-
corded on the e x t e r n a l surfaces of the
teeth r a n g e d b e t w e e n 68 a n d 76 C
with heat a n d b e t w e e n 14 a n d 20 C
when cold was used. Thus, at the
tooth surface, the m a x i m u m t e m p e r -
ature changes p r o d u c e d b y the h e a t
test were n e a r l y twice t h a t p r o d u c e d
by the cold test.
T h e times at which the initial
t e m p e r a t u r e c h a n g e occurred at the
P D J after t h e r m a l testing of the
extracted test teeth are shown in
T a b l e 1. In not a single instance was
the time it took for the initial
t e m p e r a t u r e c h a n g e to occur at the
P D J shorter t h a n the S R T . T h e
value for each t o o t h represents a n
average of six s e p a r a t e test measure-
ments, three for h e a t a n d three for
cold. Because t h e r e was no signifi-
cant difference between heat a n d
cold tests as far as the time of initial
t e m p e r a t u r e c h a n g e at the P D J was
concerned, the six m e a s u r e m e n t s
were a v e r a g e d together. T h e m e a n
time of initial t e m p e r a t u r e c h a n g e at
the P D J for all teeth tested was
3.68 + 1.15 (SD) second.s. Thus, the
m e a n S R T for b o t h heat a n d cold
testing was less t h a n h a l f the time it
took for the initial t e m p e r a t u r e
change to occur at the PDJ.
T h e rate of t e m p e r a t u r e change at
 JOURNAL OF ENDODONTICS I VOL 6, NO 1, JANUARY 1980

the P D J after a five-second a p p l i c a -

tion of heat to the extracted test teeth
is shown in Figure 1. T h e t e m p e r a -
ture c o n t i n u e d to increase for n e a r l y
Table I * Sensory response of teeth to heat and cold testing procedures, time of initial 20 seconds after the heated g u t t a -
temperature at PDJ, and distance from test site to PDJ. percha was removed from the teeth.
T h e m e a n m a x i m u m increase in
ITCt Distance temperature at the PDJ was
SRT* heat SRT* cold PDJ test site
3 . 9 _ 1.2 (SD). However, in one
Patient Age Sex Tooth no. (sec) (see) (sec) to PDJ (mm)
tooth, a m a x i m u m increase of 6.5 C
S.P. 9 F Maxillary right 1.2 2.2 3.6 3.8
was observed. A c c o r d i n g to the s t u d y
first premolar
Mandibular 1.6 2.5 2.9 3.2 by Z a c h a n d Cohen, 7 a t e m p e r a t u r e
right second increase of this m a g n i t u d e m i g h t be
premolar sufficient to p r o d u c e p u l p a l injury.
R.N. 13 M Maxillary right 1.5 1.6 2.9 3.0 T h e a m o u n t of tooth substance
first premolar
intervening between the test site on
Mandibular 1.1 1.9 5.2 4.3
right first tile tooth surface a n d the P D J is
premolar shown in T a b l e 1. T h e m e a n
J.C. 14 M Maxillary right 1.5 1.5 4.3 4.2 distance between these two points
first premolar was 3.4 --- 0.66 (SD) ram. This repre-
Mandibular 1.2 1.1 2.5 2.6
sents the distance through which the
left second
premolar heat or cold h a d to be t r a n s p o r t e d by
N.M. 11 F Maxillary left 0.8 0.9 2.1 2.3 c o n d u c t i o n in order to reach a n d
first premolar thus c h a n g e the t e m p e r a t u r e in the
Mandibular 0.6 0.8 2.8 3.0 region of the PDJ.
left first pre-
T o s t u d y the relationships be-
molar
R.W. 14 M Max!llary left 0.9 1.1 4.0 4.2 tween the initial sensory response
second pre- ( S R T ) to the a p p l i c a t i o n of heat a n d
molar cold, the initial t e m p e r a t u r e c h a n g e
Mandibular 1.3 1.2 3.6 3.7 at the P D J , a n d the distance between
left second
the test site on the surface of the
premolar
Mandibular 1.5 1.7 5.2 4.0 tooth a n d the PDJ, the d a t a were
right second analyzed using Pearson's correction-
premolar al coefficient (r). This analysis is
S.B. 11 M Maxillary right 1.5 NR:~ 2.7 2.8 presented in T a b l e 2. As shown, the
first premolar
c o m p a r i s o n between S R T - h e a t a n d
Mandibular 2.0 NR 5.7 4.2
right first S R T - c o l d established an r of 0.04
premolar that was not significant. Similarly,
J.D. 16 F Maxillary right 0.8 1.2 3.0 3.1 tile following relationships were not
first premolar significant: S R T - h e a t a n d the t i m e
Mandibular 1.2 1.2 5.4 4.2
of initial t e m p e r a t u r e change at the
right first
premolar P l ) j (r = 0.33); S R T - h e a t a n d the
G.S. 14 F Maxillary left 1.8 1.9 3.0 3.2 distance between the test site a n d the
first premolar P I ) J (r = 0.25); S R T - c o l d a n d the
~, = 1.28 1.49 3.68 3.49 initial t e m p e r a t u r e change at the
SD = +0.38 +0.50 _+1.15 +0.66
P D J (r = 0.19); and S R T - c o l d a n d
*~nsory response time. tile distance between the test site a n d
'~Tirne of initial temperature change at the PDJ.
tNo response. the P D J (r = 0.27). T h e relationship

407
 JOURNAL OF ENDODONTICS I VOL 6, NO 1, JANUARY 1980

n=16 Table 2" Pearson's correlational coefficients for sensory

+5 response time, initial temperature change at PDJ, and
distance between test site and PDJ.

SRT INT Distance test

cold PDJ site to PDJw
+4 SRT*
Heat 0.04 0.33 0.25
SRT~
o Gold 0.19 0.27
INT~
c PD3 o.9111
r
*Sensory response time to heat.
tSensory response time to cold.
~Initial temperature change at the PDJ.
w between the test site on the tooth surface and the PDJ.
o
~,+2 IlSignifieant (P < .05),

E
p-
+l
0 from the sensory units of the t o o t h
0 5 10 15
Time (sec)
Fig 1--Plot of temperature increase at PDJ associated with heat test-
ing. Heat was applied for five seconds commencing at time zero. Bars
indicate standard error of means.
between the initial temperature
change at the PDJ and the distance
between the test site and the PDJ
(r = 0.91) was found to be signifi-
cant (P <~ .05). These statistical
analyses indicate that there was no
significant difference between the
heat and cold tests with regard to the
S R T values obtained. Furthermore,
the relationship between the SRT
and the time of initial temperature
change at the PDJ was not signifi-
cant, indicating that these events
may be more or less independent of
each other. Because the time of
initial temperature change at the
PDJ would be dependent on the
amount of tooth structure through
which heat or cold would have to
20 25
diffuse, the positive relationship that
was found between these sets of val-
ues was expected.
DISCUSSION
The design of this experiment was
unique in that it attempted to relate
the sensory responses of patients in a
clinical situation with measurements
made on extracted teeth in the labo-
ratory. More specifically, an attempt
was made to establish a relationship
between a physiologic phenomenon,
the excitation of sensory nerve
endings by thermal stimulation, and
thermal conduction, a physical prop-
erty of teeth related to the transpor-
tation of heat and cold through the
enamel and dentin. The primary
objective was to relate the tempera-
ture changes in the region of the
sensory nerve endings (that is, the
PDJ) to the time when the central
nervous system first received signals
(patient perception). Because it is not
possible to insert a thermistor probe
into the pulp chamber of a vital
human tooth without using an anes-
thetic agent, it was thought that
valid measurements of thermal diffu-
sion could be made on teeth that had
been extracted immediately after
thermal testing. Hensel and Mann s
and Naylo? ~ have previously used
similar experimental models.
In the group of teeth studied, no
significant relationship was estab-
lished between the initial sensory
response produced by thermal stimu-
lation and the thickness of tooth
structure between the test site on the
surface of the tooth and the PDJ.
Thus, the time it takes for hot and
cold stimuli to diffuse through the
enamel and dentin to the PDJ does
not appear to be of critical impor-
tance in determining when the initial
sensory response occurs. These obser-
vations are in agreement with those
of Naylor, ~ who reported that the

408

thickness of dentin between the point
of application of cold and the dental
pulp could not be correlated with the
threshold temperature of sensory
stimulation. Furthermore, the results
of the current study indicate that the
temperature in the region of the PDJ
may continue to increase (or decrease
in the case of cold) for a considerable
period of time (approximately 20
seconds) after the sensory response
has disappeared. This provides furth-
er evidence that the sensory struc-
tures are not responding directly to
temperature change.
When a thermal stimulus is
applied to a tooth, the heat or cold is
transported through enamel and
dentin by conduction. Temperature
distribution in the tooth is governed
by the thermal diffusivity of the
dental tissues, and it has been shown
that diffusivity of both enamel and
dentin is relatively low.'" The results
of this study indicate that the initial
sensory response is quite rapid in
comparison with the time it takes for
the heat or cold to diffuse through
the dental tissues to the PDJ. These
findings are in agreement with those
of Hensel and Mann," who observed
that sensitivity of teeth to heat
appears before the temperature of
the pulp undergoes a significant
change. Sinfilarly, Van Hassel and
Ervin '~ reported that sensory re-
sponses to both heat and cold
preceded pulp surface temperature
changes in 91% of the teeth included
in their study. In view of the fact that
the sensory fibers are located in the
vicinity of the PDJ and do not pene-
trate the dentin for any appreciable
distance, it is highly unlikely that the
initial sensory response to thermal
testing is due to direct stimulation of
the sensory receptors by heat or cold.
Accordingly, the assertion by M u m -
JOURNAL OF E N D O D O N T I C S ' VOL 6, N O 1, JANUARY 1980
ford 1': that the patient first perceives
pain when the temperature of the
PDJ is raised to 47 C or lowered to 29
C must be questioned. A more likely
explanation is that thermal stimula-
tion of the tooth results in physical
changes within the dentin that
secondarily produce excitation of
the sensory structures. Br/innstr6m
and Johnson ':~ and Br~innstr6m"
have suggested that, when dentin is
heated or cooled, there is a rapid
movement of fluid in the dentinal
tubules that may mechanically dis-
tort the nerve fibers at the PDJ.
According to this theory, excitation
of the sensory elements would be the
result of hydrodynamic forces within
the dentin acting on mechanorecep-
tors at the sensory nerve endings.
One explanation of the results of
this study is that thermal expansion
or contraction of dentin could pro-
duce a narrowing or widening of the
dentinal tubules and thus contribute
to the hydrodynamic forces pro-
duced within the dentin. O f perhaps
greater importance is the fact that
heat or cold would increase or
decrease the volume of fluid within
the dentinal tubules. Thus, abrupt
changes in the quantity of fluid
would initiate a current within the
tubules corresponding to the flow of
fluid observed by Br/innstr6m.
Dentinal tubules extend from the
pulp to the vicinity of the dentino-
enamel junction. In young human
premolars, the diameter of the
tubules halfway between the pulp
and the enamel is approximately 1.4
#, and the number of tubules per
square millimeter in the same region
is about 30,000?:' Nearer the pulp the
tubules are wider; they narrow as
they extend toward the enamel. An
odontoblast cell process almost com-
pletely fills each tubule and extends
outward from the pulp into the prox-
imal portion of the tubule. Although
the distance between the cell mem-
brane of the odontoblast process and
the wall of the dentinal tubule has
not been accurately determined, it
has been estimated to be less than
0.02 # (J. Avery, DDS, unpublished
communication, 1979). According to
Roane and others TM and Br~inn-
str6m, ~ the odontoblast processes
terminate and are absent in the dis-
tal two thirds of the tubules. The
portion of the tubules that does not
contain odontoblast processes is
filled with free fluid (the dentinal
fluid) that is derived from the inter-
stitial fluid of the pulp. Rapid
expansion or contraction of the vol-
ume of this free fluid could produce a
rapid flow of fluid between the odon-
toblast cell process and the wall of
the tubule and, thus, across the sur-
face membrane of the receptor termi-
nal located within the space.
Because it appears that physical
forces within the dentin may be
responsible for exciting the sensory
nerve terminals, a theoretical model
was developed to examine the possi-
ble hydrodynamic forces that might
be involved in the sensory response to
thermal stimulation. Figure 2 shows
a diagrammatic representation of a
dentinal tubule. The odontoblast
process fills one portion of the tubule
(segment "b"), whereas the outer
portion of the tubule (segment "a")
contains free fluid. Expansion of the
free fluid in the outer portion of the
tubule (segment '"a") can be calcu-
lated by the following equation:
V t - V o / V o = a T (equation 1).
Where Vt = volume of free fluid
at an elevated or decreased tempera-
ture; Vo = volume of free fluid in
the outer portion of the dentinal
tubule at 34 C; a = linear coefficient
409
 JOURNAL OF ENDODONTICS ] VOL 6, NO 1, JANUARY 1980

ENAMEL ( t" o d o n t o b l a s t
~\ process
0
-r
-h PULP

L, J- b
p, a -p "I
Fig 2--Diagrammatic representation of dentinal tubule, r = radius of tubule," a = portion of tubule con-
taining free fluid; b = portion of tubule containing odontoblast process; and h = space between odontoblast
process and wall of tubule.

of thermal expansion; and T = +5

change in temperature from 34 C.
T h e increase in volume of the free
fluid in the outer portion of the
tubule can be calculated by the +4
equation: AV = 0.36 X 10 ~qr r'~a 21
T (equation 2). A

Where d~V = change in volume; o

7r r 2 = cross-sectional area of tubule;
a = length of free fluid; and AT = ~- + 3
c-
temperature change from 34 C. O

T h e rate of flow of the expanded

free fluid through the annulus cross 2
section (Fig 2, h) can be calculated
by the equation: V2 = 0.18 X 10 3
ra& T / h t (equation 3).
Where V2 = flow rate, centime-
/?'
// H Experimental
ters per second; k n o w n and esti-
mated values are r = 0.7/~ (Ahlberg +I - /// o----o Calculated
and othersl~); a = 0.2 cm (esti-
mated); h = 0.2/~ (Avery, J., u n p u b - i/
lished communication); AT = 3C
(measured temperature increase/ 0 _ I I I
sec)*; and t = 1.28 seconds (mean 0 5 I0 15 20
sensory response time as determined T i m e (sec)
by this study). Fig 3--Comparison between plot of temperature increase at PDJ based
By substituting k n o w n and esti- on experimental data (solid line) with plot of calculated values (bro-
mated values for the parameters in ken line).
equation 3, the fluid velocity can be
estimated over the surface of the postulated that this velocity m a y be be capable of deforming the surface
sensory receptor within the tubule or sufficient for the sensory receptors to m e m b r a n e of the sensory receptor,
adjacent to the orifice of the tubule distinguish a difference in state from and this would result in the initiation
within the odontoblastic layer. Thus, the previously relatively quiescent of a generator potential.'}" Second,
the fluid velocity calculated by equa- condition by one of two possible the sudden onset of fluid motion m a y
tion 3 would be 0.003 cm/sec. It is mechanisms. First, the velocity m a y change the ionic environment sur-

410

rounding the receptor a n d thus alter
the excitability of the receptor m e m -
brane.
A n o t h e r possibility worth consid-
ering is that e x p a n s i o n or contraction
of the fluid in the p o r t i o n of the
tubule that corresponds to segment
" a " in Figure 2 could result in defor-
mation of the e n d of the o d o n t o b l a s t
process. D e f o r m a t i o n of the process
could c o n c e i v a b l y d i s t u r b the deli-
cate relationship between the odon-
toblast and the sensory receptor. It
has been shown t h a t the cell
membranes of the o d o n t o b l a s t and
the terminal sensory axon run closely
parallel and t h a t the facing m e m -
branes are i m m e d i a t e l y a d j a c e n t to
each other.: A flmctional relation-
ship between these structures has
been suggested by Frank. ': Conse-
quently, d e f o r m a t i o n of the odonto-
blast could affect this relationship
and result in excitation of the recep-
tor.
T h e linear m o v e m e n t p r o d u c e d by
expansion of the fluid in segment a is
given by the formula: A a = 0.362
• t0 :~ a AT ( e q u a t i o n 4).
Where A a = the c h a n g e in length
a. By substituting the values pre-
viously given, A a = 2.2 t~ (the dis-
tance the o d o n t o b l a s t process m i g h t
be displaced by e x p a n s i o n of the free
fluid d u r i n g heat testing of the
tooth).
The calculated hydrodynamic
forces a p p e a r to be quite small.
However, in studies on excitation of
nerve impulses in the cochlca of the
inner ear, B6k6szky '~ observed that
"displacement (of the receptor m e m -
brane) whose m a g n i t u d e is the d i a m -
eter of an a t o m can p r o d u c e enough
voltage to trigger a nerve e n d i n g . "
Thus, although the h y d r o d y n a m i c
'forces p r o d u c e d by t h e r m a l testing of
teeth a p p e a r to be d i m i n u t i v e , the
a m o u n t of energy r e q u i r e d to distort
JOURNAL OF ENDODONTICS
the m e m b r a n e of the sensory recep-
tor sufficiently to initiate a g e n e r a t o r
p o t e n t i a l m a y be c o r r e s p o n d i n g l y
small. Considering t h a t there are
a p p r o x i m a t e l y 30,000 t u b u l e s / m m ~
in the area of the d e n t i n in which
h y d r o d y n a m i c forces are being gen-
erated, there must be quite a large
n u m b e r of nerve endings c a p a b l e of
p r o d u c i n g generator potentials. Ac-
c o r d i n g to Davis,'" g e n e r a t o r poten-
tials from several sensory nerve end-
ings s u m m a t e to excite all or none of
the nerve impulses (action poten-
tials) in afferent fibers that lead to
the central nervous system.
SUMMARY
In s u m m a r y , the results of this
study indicate that the sensory
response to thermal s t i m u l a t i o n oc-
curs before there is a t e m p e r a t u r e
c h a n g e in the region of the PDJ
where the sensory nerve endings are
located. Thus, it would a p p e a r that
the sensory response is not initiated
by t e m p e r a t u r e changes occurring in
the receptors. A theoretical model
has been developed to e x a m i n e the
h y d r o d y n a m i c forces that m a y be
p r o d u c e d by t e m p e r a t u r e changes
occurring within the dentin. These
forces, a l t h o u g h small, m a y be cap-
able of initiating g e n e r a t o r potentials
within the nerve endings by displac-
ing the surface m e m b r a n e s of the
sensory receptors.
APPENDIX
A p p r o x i m a t e calculations were
m a d e as a check of the m a g n i t u d e s of
the e x p e r i m e n t a l l y d e t e r m i n e d tem-
peratures. For this, an a p p r o x i m a -
tion is given by the e q u a t i o n :
T(x,t) = T o erfc(._~_x '~
\ 2 kt,]
VOL 6, NO 1, JANUARY 1980
W h e r e erfc = one minus the error
function; T ( x , t ) = the t e m p e r a t u r e
above the a m b i e n t at a time t a n d a
distance x from the tooth's o u t e r
surface; k = the effective t h e r m a l
c o n d u c t i v i t y of e n a m e l a n d d e n t i n
c o m b i n e d in series; a n d T o = m e a n
tooth surface t e m p e r a t u r e over the
time for which the calculation is
made.
For t e m p e r a t u r e s at the P D J , k is
2.25 • 10 a cm'-'/sec ( o b t a i n e d from
4.7 x 10 :i a n d 1.85 • 10-:', a n d
thickness of 0.1 cm a n d 0.24 cm for
enamel a n d d e n t i n respectively). T o
calculate T (x,t) for a period of 20
seconds to c o m p a r e with the experi-
mental d a t a , To is taken as 49 C
( c o r r e s p o n d i n g to the surface tem-
p e r a t u r e at t = 10 seconds). T h e
intercept of the calculated t e m p e r a -
rare curve occurs at 3.4 seconds,
which is the same as the e x p e r i m e n -
tal value (Fig 3), a n d the t e m p e r a -
ture rise over the a m b i e n t at the P D J
at 20 seconds is calculated to be 3.9 C
c o m p a r e d with the e x p e r i m e n t a l val-
ue of 3.8 C. W h e r e a s some points in
between 3.4 a n d 20 seconds showed
as m u c h as 0.5 C deviations, the
calculations s u b s t a n t i a l l y confirm
the reasonableness of the e x p e r i m e n -
tal data.
*This value was estimated by conducting
thermal tests on extracted teeth and measur-
ing the temperature change occurring within
the area of the dentin corresponding to
segment a in Figure 2. This was accomplished
by inserting a probe into a small hole drilled
into the dentin from the pulp chamber.
]-Generator potentials are localized, graded
depolarizations which initiate sensory signals,
whereas action pntentials travel rapidly, with-
out distortion, from one end of a nerve cell to
the other.
The informed consent of all human subjects
who participated in the experimental investi-
gation reported in this manuscript were
obtained after the nature of the procedures
and possible discomforts and risks had been
411

fully explained by the clinician who con-
ducted the tests.
Dr. Trowbridge is professor of pathology,
University of Pennsylvania School of Dental
Medicine. Dr. Franks is in private practive in
endodontics, Johannesburg, South Africa. Dr.
Korostoff is professor of restorative dentistry,
University of Pennsylvania Laboratory fnr
Research on the Structure of Matter. Dr.
Emling is assistant professor of educational
research, University of Pennsylvania School of
Dental Medicine. Requests for reprints should
be directed to Dr. Henry Trowbridge, Univer-
sity of Pennsylvania School of Dental Medi-
cine, 4001 Spruce St, Philadelphia, 19104.
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