Electric Pulp Testing in Children During Permanent Teeth Apexes Formation

Pain sensation is evolutionarily the primary basis of sensitive human activity, and it is quite stable...

the human tooth, the circulatory and nervous systems of the pulp are separated as a thin soft string and are protected from external influences by a thick tube of enamel and dentin. The nerves in the pulp are 20.5% by weight.The pulp is represented by two main pain points that determine pain sensitivity. In the crown pulp, these are odontoblasts and dentine tubes with 1-2 mm of nerve branches of A-Delta fibers entering them. At the root it is a narrow thin apical part of the canal, where the pulpar nerves of the pulp core from Cfibers are tightly placed together with the blood vessels. Secondary cement is also involved in creating the apical opening, preventing myelination of the nerve tissue there [8]. The presence of myelin A-Delta fibers in the apex has not been proven. Pain fibers A-Delta are slightly myelinated, located in the crown, have a higher rate of conduction (dentin pain). They respond to the pulse current as an acute pain sensation. C-fibers transmit late, dull and not always clear pulp pain. It is interesting that all foreign authors use A-Delta fibers [6], to consider themechanisms of electrodontometry (EOM) from the standpoint of the theory of Branstrom, with an emphasis on EPT (Electrical pulpal test) as dentin stimulation. Foreign researchers exclude the reaction of pain by C-fibers, which make up the bulk of the nerve structures of the tooth.
Interestingly, EPT is rated as a low-value test for primary or permanent teeth during apex formation [9].Many children with normal teeth do not respond even to high stimulation currents [9].
We believe that for the reaction of all neuroreceptors in single teeth, a more universal AC stimulator with a broad total effect, mainly on  at the age of 6.5 to 11 years with a furthermore gradual decline ( Figure 1).In the first age group, 13 subjects had no pain at all, and 6 (38%) subjects had a pre-pain sensation that was close to tactile.
In the second group, 4 children had no pain, and 5 had afeeling of pre-pain in the form of cold or heat with spreading in the gum above the tooth (14.5%). In the group of 9-10 years, 4 subjects had a feeling of pre-pain (7.14%), in 11-12 years in 5%, in 13-15 years in 1.92%( Figure 2).    Pain is one of the main feelings. With age, the senses improve.

Discussion of Results
The difference in pain assessment is visible on the graph (Figure 1). The youngest ones have the greatest feeling of "non-pain". Children The electric current due to its strength and the large electrode covers the entire pulp, both coronal and apical ( Figure 3). In our literature, there is a tendency to prohibit devices that operate from alternating sinusoidal current with a frequency of 50 Hz [1,2].
The regularities between the degree of tooth eruption and the reduction of its pain threshold to a minimum level, while reducing the apical narrowing, and clarifying the pain response in a young subject were determined. The formation of the apex consists in its gradual narrowing, including ingrowth of cement into the apical part of the root canal. It is dominated by C-fibers. Pulse pulp testers do not "feel" the pulp in the erupting teeth.It should be noted that when the final apex was formed, the threshold value did not always correspond to the previously accepted norm of 2-6 mkA. In one 15-year-old patient, the initial pain threshold was 125 mkA.

Conclusion
The phenomenon of reducing the pain sensitivity of permanent teeth during eruption due to the reaction of C-fibers has been established. Pulse pulp testers do not work in teeth during apex formation.

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