Dentine Sensitivity Flashcards
Definition of dentine sensitivity?
Defined as a pain arising from exposed dentin typically in response to thermal, chemical, tactile or osmotic stimuli
Needs to be distinguished from other aetiologies of dental pain
A fibres myelinated or un-myelinated?
Myelinated
A fibres fast or slow?
Fast transmission - transit pain directly to thalamus
A-beta or A-delta fibres more common?
A-beta
role of a-beta fibres?
Proprioception
Less involved in pain transmission that a-delta fibres
(Low threshold Mechanoreceptors)
role of A-delta fibres?
Involved in te initial, sharp short response to pain, not outlasting stimulus
what fibres are stimulated in pulp testing?
A-delta
what are a-delta fibres involved in?
Touch, and presssor sensors
what are A-delta fibres involved in?
Air, heat, cold, drilling, probing
c-fibres myelinated or un-myelinated?
Unmyelinated
dentine sensitivity theories?
Direct innervation
Hydrostatic theory
Odontoblasts transducer theory
Describe hydrostatic theory?
Fluid filled dentine tubules are patent at the dentine surface and within the pulp.
Dentine sensitivity is due to movement of fluid within dentinal tubules
Stimuli causes fluid movement in the dentinal tubules, which creates mechanical disturbed that are transmitted to, nerve endings near the pulp. In effect nerve endings act as Mechanoreceptors
Air blast, probing with instruments (tactile and mechanical stimuli), hypertonic solutions and cold cause pain in pulp due to movement of fluid in the dentinal tubules
Inward movement and especially outward flow of dentine tubular fluid
What are some causes of dentine hypersensitivity?
Loss of enamel or by gingival recession, which exposes underlying dentine
Gingival recession exposes dentinal tubules
Cementum layer on the root surface in thin and easily damaged
what can. Cause gingival recession?
Overenthusiastic/ over frequent brushing
Periodontology treated patients
Older people with gingival recession exposes
Recession caused by oral piercing such as tongue/ lip rings and studs
Orthodontic tx
Thin alveolar cortex, buccal or lingual dehiscence and fenestration of the alveolar bone
Bruxism
Self inflicted injury
causes of enamel loss from non-carious cervical lesion?
Attrition
Abrasion
Erosion
A fraction - micro fractures due to occlusal loading on the CEJ region
OHI and brushing technique instruction?
Diet counselling - awareness of acidic foods and beverages: vinegar, fruit, fruit juices and soft drinks causing erosion, regulation of consumption. Brush teeth before consuming these
OHI — efficient and non-traumatic technique
Use medium tb
Avoid abrasive tp
behavioral control and elimination of this - advice?
Bruxism mouth guard, restoration of OVD
Correction of premature. Occlusion using splint / occlusal adjustment
Counsel remove oral piercings if causing damage
Counsel against brushing excessively frequently
Tx f GORD
Discussing bulimia binge / purge and referral if necessary
agent for desensiting tp?
strontium chloride
In sensodyne original
standouts fluoride for sensitivity?
Sensodym rapid
duraphat effects?
Fluoride replaces hydroxyl group
Reduces sensitivity by reinforcing enamel and blocks dentinal tubules Cementum layer
2800ppm
- not prescribed to anyone under 10
5000ppm
- not prescribed to anyone under 16
agent in Colgate pro-relief?
Argenine
Forms a calcium ish mineral layer on the dentine surface, occluding dentine tubules with a plug that contains arginine
In surgery chemical txs?
Duraphat
Potassium nitrate - desensitising gel 5% and 10%
Silver diamond fluoride (SDF)
When to restore?
Hard tieeue defect visible
Aesthetics are a concern
High risk of further dentinal tissue loss if not covered with a restoration
High risk of further dentinal loss if not covered with a restoration
Failure to resolve sensitivity with non-restorative treatment
when to consider surgery?
Aesthetics are a concern for the pt
Failure to settle dentine hypersensitivity with other methods
Failed restoration ie difficulties with dentine resin bonding
