Dentinal hypersensitivity

Question 1

What is dentinal hypersensitivity?

Answer 1

A pain arising from exposed dentine, typically in response to mechanical, chemical, thermal or osmotic stimuli that cannot be explained as arising from any other forms of dental defect or pathology.

Question 2

Name and explain the different stimuli that causes dentinal hypersensitivity:

Answer 2

• Chemical- acids from fermentable carbohydrates by bacteria in dental plaque, citric acids or condiments.
• Mechanical - toothbrush filament, eating utensils, dental instruments or friction from denture clasp or appliance’
• Thermal- hot/cold foods & beverages or air entering the oral cavity
• Osmotic - concentrated solution (sugar/salts) resulting in expansion of fluid.

Question 3

Name factors contributing to exposed dentine:

Answer 3

• Fracture
• Attrition
• Abrasion
• Erosion
• Anatomical (10% have gap at CEJ between enamel & cementum
• Gingival recession (e.g. due to RSD, tooth brushing , surgery, frenulum pull)

Question 4

Explain the hydrodynamic mechanism for dentinal hypersensitivity:

Answer 4

(Brannstormm & Astrom 1964)

• most widely accepted theory
• fluid within dentinal tubules can flow inward or outward depending on pressure variations in surrounding tissue
• this movement displaces /disturbs sensory nerves of inner dentine & dentinopulpal junction activating them causing pain
• larger diameter and number of tubules means more fluid flow with given stimuli

Question 5

Name all 3 theories of dentinal hypersensitivity:

Answer 5

• Hydrodynamic mechanism
• Nerve endings in dentine (from pulp near cells of odontoblasts, no nerves have been demonstrated in periphery of dentine near dentinoenamel junction)
• Odondoblast as special sensory cell: research suggests that odontoblasts have sensory cell that passes sensations to pulpal nerve)

Question 6

What are characteristics of dentinal hypersensitivity?

Answer 6

• Short sharp pain, rapid on onset
• occurs immediately with stimulus
• no pathology can be identified

Question 7

What self care advice would you give a patient suffering from dentinal hypersensitivity?

Answer 7

• management is based on hydrodynamic mechanism
• block dentinal tubules so that fluid movement cannot persist
  SELF CARE:
  -plaque control - bacterial toxins/acids can cause sensitivity
  -desensitising dentifrices - can be applied topically:
• potassium based needs 3-4 weeks to take effect, works by stop axonic action depolarising the nerves, stops excitability of tooth
  -calcium based for instant relief arginine and cal blocks fluid movement in tubules e.g. colgate sensitive pro relief.
  -Prescribed tp duraphat 2800/5000 ppm
  -Fluoride MW (fluorigard) 1x daily NaF seperate to tb
  -0.4% stannous fluoride gel (colgate gelkem)
  -Less acidic diet - diet analysis?

Question 8

What professional management may you consider implementing?

Answer 8

-Localised sites of hypersensitivity
-More severe cases that don’t resolve with self care regimes.
-Seal dentinal tubules
-Sodium fluoride varnish 2.26% or 5% e.g. colgate duraphat varnush
- Stannous flouride 0.4% tray applications in surgery, patient continue daily applications are home (Colgate gelkem)
- Gluteraldehyde 5% and HEMA preparation (cotton wool roll application, avoid soft tissues as gingival irritant, Heraeus Gluma Desensitiser
- Resins seal tubules (may need la)
-Dentine sealers (more comfortable application
-Periodontal surgery
-Restorations
START WITH LEAST INVASIVE FIRST