Dentine hypersensitivity and gingival recession Flashcards
what is gingival recession?
- gingival margin positioned apical to the cement enamel junction with exposure of the root surface
what is the pocket depth,attachemnt level and gingival recession lengths in gingival recession
- base of pocket to gingival margin (4.5mm)
- attachement level; CEJ to base of pocket (7.5mm)
Gingival recession: CEJ to gingival margin (3mm)
what is the prevalence of gingival recession
Recession of 1mm or more in 58% of adults age 30+
increase prevalence and extent with age
- 37.8% and extent of 8.6% of teeth in 30-39 year olds
- 90.4% and extent of 56.3% in 80-90yrold
what is the distribution of gingival recession
- maxillary 1st molars and mandibular central incisors
-upper and lower canine,1st premolar and incisor teeth- define hypersensitivity
where is greater gingival recession common in
- left side of jaw
- Males V females
- Afrocarribeans V white Caucasian
- good oral hygiene associated with buck surfaces (overbrushing)
- poor oral hygiene associated with lingual surfaces of lower anterior teeth
what is the aetiology of recession
- normal sulcus and undiseases interdental crystal bone
- anatomical position of tooth
extent of cortical bone
tooth position in arch - Orthodontic tooth movement
creation of dehiscnece
volume of soft tissues
greater risk of recession with excessive proclamation of lower incisors and arch expansion
Periodontal disease
Trauma - foreign bodies- lower lip piercing
finger nail picking
toothbrushing- hard toothbrush - partial dentures, gingival stripping
topical cocaine
In recession and keratinised tissue what is the width and thickness
- certain epic-coronal width of keratinised tissue required
- no minimum width
- thickness and texture of pre attached ginger
- thin, fragile tissue predisposed to recession in presence of plaque induced inflammation or trauma
is it thin or thick gingivae where recession is more likely to occur
- thin gingivae
what are the local plaque retention factors
- calculus
- subgignval margins increase plaque retention
- more pronounced inflammation see in thin ginger
- does increase in thickness decrease risk of recession
what are consequences of recession
- fear of tooth loss
- plaque accumulation and bleeding gignva
-aesthetics
-root caries - abrasion
- pain from dentine hypersensitivity
what is dentine hypersensitivity
- characterised by short, sharp pain arising from exposed dentine in response to certain stimuli which cannot be explained as arising form any other dental defect or disease
- It may go on to manifest as a dull ache beyond the duration of the stimulus, possibly as an altered plural response
explain the epidemiology of dentine hypersensitivity
- The prevalence distribution and appearance of the disease have been reported differently in different studies. These differences are due to the differences in populations, habits,diets and methods of investigation
- peak incidence is 20-40 years
- perceived by patient/self reported 8-30%
- GENDER BIAS TO SNESITVITY f>m
In which order are the most often affected teeth in dentine hypersensitivity
buccal/labial and cervical areas
- first premolars
- canines
- incisors
- second premolars
- molars
Describe the aetiology of dentine hypersensivtity
dentine exposure (lesion localisation )
- Tubules made patent (lesion ignition)
+ stimulus
but pulp must be vital
describe the brannstrom hdyrodynamic hypothesis
Dentien hypersensitivity caused by movement of dentinal tubule contents
- Increased outward fluid flow causes a pressure change across the dentine
- Distortion of A-delta fibre causes pain
Name other possible mechanisms of sensitivity condition
- odontoblasts as receptors - inconclusive
- nerves in dentine ( only seen in 1% of tubules in the cervical margin, however electrical current and cold stimulate nerves directly
- Hydrodynamic mechanism
describe the hydrodynamic mechanism of pulp nerve activation
- stimulus affects dentinal tubules
- odontoblasts with odntobalst process extending partway to tubules and nerves
- A delta/beta fibre conduct impulse form pain experienced for pulp
-fluid flow changes also result in electrical discharge which may be able to stimulate nerves electrically
rate of fluid flow depends on 4th power of the radius
if a tubule is twice the width fluid flow is 16 X greater
what does a sensitive dentine show
- A disrupted smear layer
- may more dentinal tubules at the surface
- tubules not occluded by deposit
- tubule diameter wider
what is root sensivtity
- term proposed for dentine hypersensitivity form gingival recession due to periodontal disease and treatment
- potentially microorganisms invading root dental tubules
which factors allow dentine to become exposed
- resulting form loss of enamel
- removal of enamel by restorative procedures
-attrition
-abrasion
-erosion - combined erosion and abrasion
how does erosion occur
- intrinsic or extrinsic source of acids
- enable and dentine loss and surface softening
- increase tooth surface loss by toothpaste abrasion in intra oral environment acid
-pH of the acid is not the only factor in erosion - Type,chemcial strength,temeprartue,exposrue time are other variable s
- Think of fruits other than citrus,health supplements, mouthwashes,fruit teas,alcopops
how does the dentine become exposed
- gingival recession occurs exposing root surface covered with cementum
- cementum a relatively weak structure in thin layer
- cementum not designed to be exposed in the real environment
- wear and tear including toothbrushing readily remove cementum and expose the dentine beneath
how does toothbrushing contribute to dentine hypersensitivity/gingval recession
- toothbrush design/bristles may contirbtue
- abrasive particles may remove the smear layer and open retinal tubuels
- detergents might help to remove the smear layer
- tubules could be occluded with particulate matter form the paste
how is hypersneitvity managed
Tubule occlusion
- promotes formation of new tissue e.g smear layer, intratubualr dentine,tertiary dentine in response to stimulus or trauma
- application of an artificial barrier.g varnish,dentine ,bonding agents,composite resins, GICs and toothpastes
Blocking plural nerve repsonse
- potassium ions diffuse along tubules and raise extracellualr K+ conc, reducing nerf excitailtity
-un proven in human
- clinically unlikely that ions will diffuse into tubules against flow of dentinal
Ideal quality software barrier materials
- retentive
- insoluble
- penetrate tubules
- form oecnaila tags into tubules
-seal the end of tubules
managing hypersensitivity ; home use products
- toothpaste,gels and mouthwashes
- contain potassium, strontium, oxalates ns fluoride salts
- Novamin - releases calcium and phosphate ions from saliva to give a HAP like layer
describe the Evaluation of efficacy
- inherent problems of clinical trial s
- pain perception is subject,qualitative and open to individual interpretation
- psychological medical, gender and cultural issues abound
- stimulus variable or fixed
- response is often complex
- unable to examine effects on subjects tissue
Describe the placebo effect
- all products achieved a modest reduction in hypersensitviety
- irrespective of presence of active ingredients
placebo effect of 40%
describe how to manage hypersensitivity in surgery
- varnish duraphat
clinpro - 1-3 layers of adhesive resin bonding systems / seal and protect, optioned solo.scothc bond
- desensitising polishing paste
- reinforced GIC where theirs abrasion cavity progression
- watch for overhangs at the gingival margin
describe rpevenatiave patient advice
- smoking cessation
- reduce risk factors- diet history, limit acidic drinks,nightime splints OHI
- orthodontic therapy
-partical dentures and restorations
How is root caries treated
- radigraphas to detect root caires interporximally
- prevention; diet OHi
-prevntion; flruodie,mouthrinses, gels, custom amde trays , topical professional application - recontuirng shallow lesions
-conventional restoration
how is periodontal disease treated?
initial therapy
correctiev therapy
supportive therapy
how are aesthetics restores from gingival recession
- reassure re further progression
- removable gingival veneer silicone or acrylic
-mask to cover the black traingles of interdental spaces - crowns and veneers
- root coverage
