Dentinal Hypersensitivity Flashcards

1
Q

Define dentinal hypersensitivity

A

Dentinal hypersensitivity is known as dentinal pain due to thermal, mechanical, chemical or osmotic stimuli. The pain subsides quickly when the stimulus is removed

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2
Q

Identify risk factors contributing to dentinal hypersensitivity

A

Gingival recession, attrition and abfraction, loss of enamel

• Non-surgical / surgical periodontal therapy
§ resulting in resolution of inflammation = exposes more tooth root surface
§ shrinkage of oedematous tissue

  • Attachment loss due to repeated instrumentation in shallow pockets with no calculus
  • Incorrect tooth brushing pressure (dependent on biotypes)
  • Use of abrasive toothpastes
  • Restorative procedures / oral surgery: polymerisation shrinkage or not using an appropriate lining
  • Anatomy of CEJ: may be a gap between the CEJ
  • Thin cementum which is readily removed during surface debridement & polishing
  • Chemical reactions: associated with plaque, bulimia and diet
  • Parafunctional habits: grinders
  • Root caries
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3
Q

Identify situations that mimic dentinal hypersensitivity

A

Cracked tooth syndrome
• Defective restorations & marginal leakage
• Fractured or chipped teeth or restorations
• Dental caries
• Sensitivity following restorative treatment
• Incomplete polymerization of restorative materials

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4
Q

Define and discuss causes of classic recession

A

An inflammation free clinical condition characterized by apical retreat of the facial oral gingiva
• Dehiscence and fenestrations are seen

Causes
• Primarily caused by morphology and anatomy: facial plate of bone is very thin
• Anterior and premolars are most affected
• Improper, traumatic tooth brushing
• Frenum pulls
• Orthodontic treatment: tooth movement labially, arch expansion
• Interdental papilla fill entire embrasure area in young patients

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5
Q

Define Stillman’s cleft

A

Relatively rapid formation of a small groove in the gingiva which can extend into a pronounced recession

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6
Q

Define McCall’s festoon

A

As a consequence of recession, the remaining attached gingiva may become thickened and rolled

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7
Q

List characteristics of classical recession

A

May be localized or generalised
• Periodontal supporting structures are usually healthy
• Teeth are not excessively mobile
• No tooth loss due to classical gingival recession alone
• If OH is inadequate, may lead to secondary inflammation and eventually pocket formation

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8
Q

Discuss the diagnosis of gingival recession

A

Established through:
• Patient history
• Clinical examinations and application of a stimuli
• Radiographs: it’s not caries

Determine cause of recession:
• Classical recession
• Pocket formation- periodontitis, treated or untreated

Consider risk factors:
• cervical abrasion
• predisposition to root caries

Consider symptoms:
• Increased secondary dentin
• Dentinal sensitivity

Measure:
• Vertical measurement from CEJ to base
• Horizontal measurement: width of tooth

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9
Q

Define dehiscence and fenestrations

A

Dehiscence:
Incomplete coverage by bone from the CEJ down to an area of the root

Fenestrations:
Bone loss on the facial or lingual aspect of a tooth that exposes the root surface to the mucosa/ periosteum

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10
Q

Discuss the management of hypersensitivity

A

Instrumenting areas with existing hypersensitivity may result in sharp pain. LA may be necessary for patient comfort

  • Most instrumentation of root surfaces does not cause dental hypersensitivity because of the smear layer
  • The smear layer is debris from the tooth surface that covers dentinal tubules inhibiting fluid flow, thus preventing sensitivity

• Most areas of hypersensitivity eventually desensitize on their own because dentinal tubules go through a natural process of crystallization and occlusion

• Strategies for intervention and management can include:
○ Chemical management
○ Patient education

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11
Q

List the classifications for recession

A
  • Class I: recession does not extend to the mucogingival junction and there is no tissue loss in the interproximal area. Localised
  • Class II: recession extends to or beyond the mucogingival junction. There is no periodontal or tissue loss in the interproximal area. Localised
  • Class III: recession extends to or beyond the mucogingival junction, into the mobile mucosa. Bone or soft tissue loss is present in the interdental area
  • Class IV: recession extends to or beyond the mucogingival junction with alveolar bone and soft tissue loss.
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12
Q

Explain Brännström’s hydrodynamic theory of pain transmission

A
  • A stimulus (cold, heat or blast of air) on exposed dentin causes rapid fluid movement within dentinal tubules
  • This fluid movement stimulates nerve endings of the pulp associated with odontoblastic processes, causing pain
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13
Q

Discuss and cite examples of tactile (mechanical ) pain stimuli

A
Toothbrush bristles
• Eating utensils
• Dental & periodontal instruments
• Friction from denture clasps or other appliances
• Oral habits
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14
Q

Discuss and cite examples of chemical pain stimuli

A
Acids in different forms
○ excessive intake of carbonated beverages
○ bacterial plaque acid production
○ citrus fruit acid
○ wine
○ condiments
○ spices
○ stomach acids (assoc. with gastric reflux, morning sickness, etc.)
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15
Q

Discuss and cite examples of thermal pain stimuli

A

hot or cold foods / beverages

• Air

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16
Q

Discuss and cite examples of osmotic pain stimuli

A

• concentrated salt or sugar solutions induce fluid movement which stimulates nerve endings & causes pain

17
Q

Define dentinal hypersensitivity

A

transit pain arising from exposed dentine. the cause of identical hypersensitivity depends on particle or total loss of enamel

18
Q

discuss desensitizing dentifrices available

A
Sensodyne
Duraphat
Arginine- colagte sensitive pro 
laser
sodium citrate 
glutaraldehyde with HEMA
GIC
Silver fluoride- Riva Star
Potassium Iodine- Riva Star
19
Q

list steps involved in diagnosing dentinal hypersensitivity

A
  • Thorough patient history
  • radiographic evaluation
  • clinical examination
  • specific questioning about stimuli
  • clinical application of air, cold spray or mechanical exploration
20
Q

List four ways dentinal hypersensitivity can naturally and spontaneously resolve

A
    • teeth goo through a natural process of occlusion of open tubules. This can be accelerated through the use of desensitizing dentifrices and fluoride and saliva minerals
    • Tubular scelorsis- occurs naturally as root dentine ages but can also be caused by trauma, abrasion and bacterial invasion
    • secondary dentine- which forms due to irritation and stimulation
    • calculus formation
21
Q

state the ingredients in toothpaste for sensitive teeth

A
  • potassium nitrate

- Strontium chloride

22
Q

state desensitising fluorides (are not remineralising )

A
  • Stannous Fluoride

- Sodium Fluoride