Acute Dental Pain Elevates Salivary Calcitonin Gene Related Peptide

Objectives: Orofacial pain is a disabling condition impacting approximately 28% of the population in the USA, and is associated with considerable individual and economic burden. Much is unknown regarding mechanisms underlying acute and chronic dental pain, an obstacle to effective pain management in these patients. Development of a readily accessible minimally invasive technique that can detect pain dependent changes would be a significant advance in diagnostics and pain research endeavors. This study explored the hypothesis that acute dental pain elevates saliva calcitonin gene related peptide (CGRP), a molecular marker of pain.
Methods: Patients were recruited from the Oral Health Center Urgent Care Clinic at the University of New England. Patients filled out a survey to determine age, gender, level of pain on a visual analogue scale (VAS) of 1-10, pain duration, history of chronic craniofacial conditions, use of analgesics in the last 24 hours and use of steroids. Saliva samples were collected using the passive drool method. Saliva from 10 female and 10 male patients experiencing acute dental pain in the absence of chronic craniofacial pain were analyzed for CGRP using a commercially available ELISA assay.
Results: Salivary CGRP was elevated in females and males compared to naive controls. Patients reporting moderate to severe pain (VAS 5-10) had higher salivary CGRP compared to patients reporting mild pain (VAS 0-4) in both males and females.
Conclusions: Our data demonstrate the feasibility of measuring the neuropeptide CGRP in saliva. CGRP was elevated in men and women with acute dental pain. This non-invasive procedure could pave the way to explore mechanisms underlying dental pain states including acute and chronic pain states, as well as determine differences between males and females in response to acute pain.