CSA dentine hypersensitivity Flashcards
What is dentine hypersensitivity?
- • short sharp pain from exposed dentine in response to certain stimuli
• Pain may develop into dull ache longer duration of stimulus
What is the epidemiology of hypersensitivity ?
self-reported problem with patient complaining of pain
When can hypersensitivty be easy see and measure?
with gingival recession
Where is hypersensitivity frequently found?
buccal/labial/cervical areas of teeth • most commonly affected teeth order: 1. First pre-molars 2. Canines 3. Incisors 4. Second premolars 5. Molars
what is present in areas of dentine hypersensitivity ?
gingival recession
- thin enamel
• cementum lost
What is aetiology of dent. hypersensitivty?
- Dentine exposed
- tubules in dentine available so stimuli may affect it (lesion initiation)
- stimulus must be present
- Pulp must be vital
What sort of stimuli are there for hypersen.?
- Thermal
- Osmotic
- Micro-organisms & their metabolites may penetrate tubules
- Desiccation
- Electrical (pulp testing)
- Tactile Touching, probing, tooth brushing
What are the conduction of pain mechanisms?
- Odontoblasts as receptors
- Nerves in the dentine may conduct pain
- Hydrodynamic mechanism
What is the hydrodynamic hypothesis for hypersen?
movement of fluid in dentinal tubules
• Increased outward fluid flow causes pressure change across dentine
• Activation of A-delta fibres cause pain
What is the other process of hydrodynamics?
- Fluid flow changes result in an electrical discharge
* may be able to stimulate nerves electrically
What is fluid flow dependant on?
TUBULE WIDTH ( to fourth power) •If tubule twice width, fluid flow 16 times greater
where to look for where hypersen. is present?
- disrupted smear layer is present
o more dentinal tubules are at surface
o Tubules not occluded by deposits
o Tubule diameter is wider
How is dentine exposed?
- loss of cementum after gingival recession
- Over-zealous oral hygiene habits
- Periodontal disease and treatment
- Badly designed dentures, ill-fitting prosthetics & poor restorations
What is dentine exposure dependant on?
o Poor bone coverage/dehiscence o Tooth anatomy o Tooth position o Ageing o Acute gingival infections
What is root sensitivity?
dentine hypersensitivity caused by gingival recession due to periodontal disease & treatment
What is dentine exposure due to a loss of enamel?
- Caused by attrition/abrasion/erosion
* Restorative processes
How can tooth brushing and paste contribute to hypersen?
- Tooth paste potential to abrade dentine
* Design of toothbrush/bristles may contribute indirectly
How does toothpaste contribute to hyper?
o Abrasive particles ,may remove the smear layer and open the tubules
o Detergents might remove smear layer
o Tubules could be occluded with particulate matter from paste
how does erosion help hypersen?
•Enamel & dentine loss and surface softening may occur
How does a acidic intra oral enviro help?
incr. Tooth surface loss by tooth paste abrasion
What is other factors besides PH of acid in erosion?
o Type/Chemical strength/Temperature/Exposure/Time
o Patients own saliva buffering capability
What is classic diagnsosis for hyper?
short, sharp pain that lasts as long as the stimulus
o Main stimuli cold or evaporate
What is differential diagnosis >
o Cracked tooth syndrome (crack from enamel to dentine)
o Incorrect placement of dentine bonding agents
o Fractured restorations
o Pulpal response to caries & restorative treatment
o Restorative left high in occlusion
o Palato-gingival groove
o Chipped tooth
o Vital bleaching
How do reduce risk factors of hypersensitivity?
o Improving toothbrush techniques (modified BASS),
o Periodontal screening & treat early
- Take a diet history
- Limit acidic drinks & match with brushing habits
o Night time splints if wear from bruxism occurs
How to manage hypersen?
tubule occlusion
blocking pulpal nerve response
What does tubule occlusion involve ?
formation of new tissue eg: smear layer, intratubular dentine, tertiary dentine in response to stimulus or trauma
- application of artificial barrier
What does blocking pulpal nerve response involve?
o Potassium ions diffuse along tubules and raise extracellular K+ conc, reducing nerve excitability
o Unproven in humans
What are the ideal qualities of a barrier material?
- Retentive
- Insoluble
- Penetrate tubules
- Form mechanical tags into tubules
- Seal the end of tubules
What are home products to help hypersesn?
- Toothpastes, gels and mouthwashes
* Sensodyne
What does sensodyne do?
repair & protect, releases calcium and phosphorus ions from saliva to give a hydroxyapatite like layer blocks the dentine
What does toothpaste contain?
o Contain potassium, strontium, oxalate and fluoride salts
what do strontium acetate products do?
withstand immersion in acid so tubule occlusion achieved
What are surgery products that manage hypersen?
- Varnish e.g. Duraphat
- 1-3 layers of adhesive resin bonding systems
- Desensitizing polishing paste (calcium carbonate and arginine)
- Reinforced GIC where abrasion cavity progression
Why should we look for overhangs?
get gingival recesiion & even more exposed dentine
Why is the comparison of efficacy?
- Fluoride varnish >may be dissolution over time
- Resins >Good if film thickness adequate, may require etching
- GIC >Good at occluding tubules where indicated for use
