Dentine Hypersensitivity

Question 1

what is dentine hypersensitivity?

Answer 1

short, sharp pain arising from exposed dentine in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology

Question 2

what needs to be excluded to diagnose dentine hypersensitivity?

Answer 2

all other possible causes of pain

it is a differential diagnosis

Question 3

what are the leading causes of dentinal hypersensitivity?

Answer 3

tooth wear (attrition, abrasion and erosion)

gingival recession

Question 4

what is the pathophysiology of dentine hypersensitivity?

Answer 4

exposed open tubules allow fluid movement in tubules, which excites nerves and leads to pain

Question 5

what is the prevalence of dentine hypersensitivity?

Answer 5

1 in 3 patients

Question 6

what is the burden of dentine hypersensitivity?

Answer 6

negative impact on quality of patient’s daily life

Question 7

types of stimuli which can trigger dentine hypersensitivity

Answer 7

• chemical
• physical
• temperature
• osmotic (sweet/ spicy food and drinks)
• tactile

Question 8

what can cause gingival recession?

Answer 8

too good oral hygiene (over brushing)

periodontal disease (poor oral health)

Question 9

how many dentinal tubules are in a mm squared of dentine?

Answer 9

approx. 32 thousand

Question 10

what are the 4 types of pain that can be in the oral cavity?

Answer 10

• joint pain
• sinus pain
• dental pain
• soft tissue pain

Question 11

what is joint pain in the oral cavity?

Answer 11

from the major joints of the jaw or neck

can be debiltating

Question 12

what is sinus pain in the oral cavity?

Answer 12

from the sinus cavities with the jawbone

above the roots of the upper molar teeth

Question 13

what is dental pain in the oral cavity?

Answer 13

from the teeth or surrounding tissues

pain can be short and sharp or lasting and throbbing

causes include caries, infection and dentine hypersensitivity

Question 14

what is soft tissue pain in the oral cavity?

Answer 14

from the tissues lining the mouth and tongue

can be caused by irritation, ulcers or trauma e.g. burns or scrapes

Question 15

what are the 2 treatment methods for dentine hypersensitivity?

Answer 15

potassium salts (e.g. potassium nitrate)

tubule occlusion

Question 16

how do potassium salts help resolve dentine hypersensitivity?

Answer 16

• Acts on nerve ending in pulp of tooth and desensitise it

- Can take up to 2 weeks to start working

Question 17

how does tubule occlusion resolve dentine hypersensitivity?

Answer 17

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

Question 18

how does novamin work?

Answer 18

• 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

Question 19

what chemical is in some toothpastes which patients can react to?

Answer 19

sodium lorosulphate SLS

Question 20

how does stannous fluoride work?

Answer 20

• 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

Question 21

what can be a knock on effect of dentine hypersensitivity?

Answer 21

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