Dentine Hypersensitivity Flashcards
what is dentine hypersensitivity?
short, sharp pain arising from exposed dentine in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology
what needs to be excluded to diagnose dentine hypersensitivity?
all other possible causes of pain
it is a differential diagnosis
what are the leading causes of dentinal hypersensitivity?
tooth wear (attrition, abrasion and erosion)
gingival recession
what is the pathophysiology of dentine hypersensitivity?
exposed open tubules allow fluid movement in tubules, which excites nerves and leads to pain
what is the prevalence of dentine hypersensitivity?
1 in 3 patients
what is the burden of dentine hypersensitivity?
negative impact on quality of patient’s daily life
types of stimuli which can trigger dentine hypersensitivity
- chemical
- physical
- temperature
- osmotic (sweet/ spicy food and drinks)
- tactile
what can cause gingival recession?
too good oral hygiene (over brushing)
periodontal disease (poor oral health)
how many dentinal tubules are in a mm squared of dentine?
approx. 32 thousand
what are the 4 types of pain that can be in the oral cavity?
- joint pain
- sinus pain
- dental pain
- soft tissue pain
what is joint pain in the oral cavity?
from the major joints of the jaw or neck
can be debiltating
what is sinus pain in the oral cavity?
from the sinus cavities with the jawbone
above the roots of the upper molar teeth
what is dental pain in the oral cavity?
from the teeth or surrounding tissues
pain can be short and sharp or lasting and throbbing
causes include caries, infection and dentine hypersensitivity
what is soft tissue pain in the oral cavity?
from the tissues lining the mouth and tongue
can be caused by irritation, ulcers or trauma e.g. burns or scrapes
what are the 2 treatment methods for dentine hypersensitivity?
potassium salts (e.g. potassium nitrate)
tubule occlusion
how do potassium salts help resolve dentine hypersensitivity?
- Acts on nerve ending in pulp of tooth and desensitise it
- Can take up to 2 weeks to start working
how does tubule occlusion resolve dentine hypersensitivity?
Block the tubule
- Novamin (bioglass) – calcium phosphate, sodium and silica (calcium sodium phophosilicate)- and stannous fluoride – depending on formulation
Fills it up
Prevent fluid movement
Forms a smear layer on top of dentine – stops stimuli triggering
how does novamin work?
- reacts with saliva in the mouth
- binds to collagen fibres in the dentine
- Gradually releases calcium and phosphate which block the tubules and form a layer over the dentine
- Layer is similar to hydroxyapatite
- Layer is a lot stronger than natural dentine - 50%. So reduces sensitivity, promote remineralisation and helps protect that area from future damage
what chemical is in some toothpastes which patients can react to?
sodium lorosulphate SLS
how does stannous fluoride work?
- builds a layer on dentine, occludes tubules and helps to reduce plaque formation and gingivitis
Been around for a while
Activated by water
- Anhydrous toothpaste only
Carbon polymer is activated by saliva builds a gel like scaffold in tubules, holds stannous fluoride within the tubule
62% improvement in sensitivity over 8 weeks compared to normal toothpaste
what can be a knock on effect of dentine hypersensitivity?
people avoid the painful area when brushing leading to plaque build-up and gingivitis
may not attend dental appointments as apprehensive because hypersensitivity can be triggered by tools
