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CSA clinical aspects > CSA dentine hypersensitivity > Flashcards

CSA dentine hypersensitivity Flashcards

1
Q

What is dentine hypersensitivity?

A
  • • short sharp pain from exposed dentine in response to certain stimuli
    • Pain may develop into dull ache longer duration of stimulus
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2
Q

What is the epidemiology of hypersensitivity ?

A

self-reported problem with patient complaining of pain

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3
Q

When can hypersensitivty be easy see and measure?

A

with gingival recession

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4
Q

Where is hypersensitivity frequently found?

A 
buccal/labial/cervical areas of teeth 
• most commonly affected teeth order:
1.	First pre-molars
2.	Canines
3.	Incisors
4.	Second premolars
5.	Molars
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5
Q

what is present in areas of dentine hypersensitivity ?

A

gingival recession
- thin enamel
• cementum lost

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6
Q

What is aetiology of dent. hypersensitivty?

A
  • Dentine exposed
  • tubules in dentine available so stimuli may affect it (lesion initiation)
  • stimulus must be present
  • Pulp must be vital
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7
Q

What sort of stimuli are there for hypersen.?

A
  • Thermal
  • Osmotic
  • Micro-organisms & their metabolites may penetrate tubules
  • Desiccation
  • Electrical (pulp testing)
  • Tactile Touching, probing, tooth brushing
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8
Q

What are the conduction of pain mechanisms?

A
  • Odontoblasts as receptors
  • Nerves in the dentine may conduct pain
  • Hydrodynamic mechanism
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9
Q

What is the hydrodynamic hypothesis for hypersen?

A

movement of fluid in dentinal tubules
• Increased outward fluid flow causes pressure change across dentine
• Activation of A-delta fibres cause pain

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10
Q

What is the other process of hydrodynamics?

A
  • Fluid flow changes result in an electrical discharge

* may be able to stimulate nerves electrically

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11
Q

What is fluid flow dependant on?

A 
TUBULE WIDTH ( to fourth power)
•If tubule twice width, fluid flow 16 times greater
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12
Q

where to look for where hypersen. is present?

A
  • disrupted smear layer is present
    o more dentinal tubules are at surface
    o Tubules not occluded by deposits
    o Tubule diameter is wider
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13
Q

How is dentine exposed?

A
  • loss of cementum after gingival recession
  • Over-zealous oral hygiene habits
  • Periodontal disease and treatment
  • Badly designed dentures, ill-fitting prosthetics & poor restorations
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14
Q

What is dentine exposure dependant on?

A 
o	Poor bone coverage/dehiscence 
o	Tooth anatomy 
o	Tooth position 
o	Ageing 
o	Acute gingival infections
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15
Q

What is root sensitivity?

A

dentine hypersensitivity caused by gingival recession due to periodontal disease & treatment

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16
Q

What is dentine exposure due to a loss of enamel?

A
  • Caused by attrition/abrasion/erosion

* Restorative processes

17
Q

How can tooth brushing and paste contribute to hypersen?

A
  • Tooth paste potential to abrade dentine

* Design of toothbrush/bristles may contribute indirectly

18
Q

How does toothpaste contribute to hyper?

A

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

19
Q

how does erosion help hypersen?

A

•Enamel & dentine loss and surface softening may occur

20
Q

How does a acidic intra oral enviro help?

A

incr. Tooth surface loss by tooth paste abrasion

21
Q

What is other factors besides PH of acid in erosion?

A

o Type/Chemical strength/Temperature/Exposure/Time

o Patients own saliva buffering capability

22
Q

What is classic diagnsosis for hyper?

A

short, sharp pain that lasts as long as the stimulus

o Main stimuli cold or evaporate

23
Q

What is differential diagnosis >

A

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

24
Q

How do reduce risk factors of hypersensitivity?

A

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

25
Q

How to manage hypersen?

A

tubule occlusion

blocking pulpal nerve response

26
Q

What does tubule occlusion involve ?

A

formation of new tissue eg: smear layer, intratubular dentine, tertiary dentine in response to stimulus or trauma
- application of artificial barrier

27
Q

What does blocking pulpal nerve response involve?

A

o Potassium ions diffuse along tubules and raise extracellular K+ conc, reducing nerve excitability
o Unproven in humans

28
Q

What are the ideal qualities of a barrier material?

A
  • Retentive
  • Insoluble
  • Penetrate tubules
  • Form mechanical tags into tubules
  • Seal the end of tubules
29
Q

What are home products to help hypersesn?

A
  • Toothpastes, gels and mouthwashes

* Sensodyne

30
Q

What does sensodyne do?

A

repair & protect, releases calcium and phosphorus ions from saliva to give a hydroxyapatite like layer  blocks the dentine

31
Q

What does toothpaste contain?

A

o Contain potassium, strontium, oxalate and fluoride salts

32
Q

what do strontium acetate products do?

A

withstand immersion in acid so tubule occlusion achieved

33
Q

What are surgery products that manage hypersen?

A
  • 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
34
Q

Why should we look for overhangs?

A

get gingival recesiion & even more exposed dentine

35
Q

Why is the comparison of efficacy?

A
  • 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

CSA clinical aspects (13 decks)

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