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CSA SR > Gingival Recession and Dentine Hypersensitivity > Flashcards

Gingival Recession and Dentine Hypersensitivity Flashcards

1
Q

What is gingival recession

A

A situation where you can see the CEJ and underlying gingival margin

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2
Q

Where does the gingival margin lie on a tooth with gingival recession?

A

Gingival margin lies apical to the cemento enamel junction

Root surface may be exposed

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3
Q

How many adults age 30 + suffer from recession of 1mm or more?

A

58%

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4
Q

Describe generally the distribution of gingival recession

A

Maxillary 6 and mandibular 1

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5
Q

Patients with gingival recession on their buccal surfaces have god or bad oral hygiene?

A

Good oral hygiene

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6
Q

Patients who have gingival recession associated with the lingual surfaces of they lower anteriors have god or bad oral hygiene?

A

Poor

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7
Q

What is the aetiology of gingival recession?

A
  1. Normal sulcus and undiseased interdental crestal bone
  2. In periodontal disease
  3. Orthodontic tooth movement
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8
Q

Aside from periodontal disease why might a patient suffer from gingiva recession?

A
  1. Trauma
  2. Post treatment
  3. Smoking
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9
Q

Give some examples of trauma that may lead to gingival recession

A
  1. Foreign bodies
  2. Finger nail picking
  3. Toothbrushing (eg brushing too hard etc)
  4. Chemical trauma from topical cocaine
  5. Partial dentures that are poorly designed or painted
  6. Poor oral hygiene
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10
Q

What type of tooth brushing technique is most likely to lead to gingival recession?

A

Scrubbing instead of using a more rounded technique

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11
Q

What do we mean by the keratinised tissue?

A

Tissue above the mucogingival junction is keratinised

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12
Q

What happens to keratinised tissue I a person suffering from gingival recession ?

A

It becomes reduced

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13
Q

What do we mean by gingival biotype?

A

The thickness of tissue

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14
Q

The talking about the gingival biotype are we talking about the height o thickness of keratinised tissue?

A

Thickness

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15
Q

Is recession more likely in thin or thick tissue?

A

Thin

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16
Q

Is there a minimum width you need to have to reduce your chances of getting gingival recession? If so what is it?

A

no theres not a minimum width

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17
Q

Describe gingival hat inmost likely to suffer from gingival recession?

A

Thin fragile tissue is predisposed to recession in the precesence of plaque induced inflammation or trauma

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18
Q

Give examples of some local plaque retention factors that relined to gingival recession

A
  1. High muscle attachment of the lip
  2. Frenal pull
  3. Restorative dentistry
  4. Calculus
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19
Q

Is the frenum keratinised tissue?

A

No it is oft

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20
Q

Why can a feral pull become a plaque retentive factor ?

A

As bushing the anteriors may resulting you talking your frenum which will then become are and resulting the patient avoiding their anterior teeth when brushing

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21
Q

How can restorative dentistry become a plaque retentive factor that may lead to gingival recession?

A

Subgingival margins on restorations may increase plaque retention

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22
Q

Why does periodontal disease sometimes lead to gingival recession?

A

As patients will get bone loss and theres apical migration f the soft tissue

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23
Q

How can a patient get recession post treatment?

A

If we scale enthusiastically gums may become inflammation and one the inflammation dies down patient may have recession

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24
Q

Where can inhaled tobacco pool in the mouth?

A

Palatal side of the central incisors

not every smoker will have this

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25
Q

What are the possible consequences of gingival recession?

A
  1. Fear of tooth loss
  2. Plaque retention/ bleeding gingivae
  3. Aesthetics
  4. Root caries
  5. Abrasion
  6. pain due to dentine hypersensitivity
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26
Q

How is dentine hypersensitivity characterised?

A

Characterised by short, sharp pain

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27
Q

What causes the short sharp pain patients experience when they have dentine hypersensitivity?

A

Due to exposed dentine which becomes sensitive in response to a certain stimuli

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28
Q

What can dentine hypersensitivity manifest as?

A

May manifest as a dull ache beyond the duration of the stimulus, possibly as an altered plural response

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29
Q

In what age does dentine hypersensitive peak?

A

20-40 year olds

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30
Q

Is there a gender bias to dentine hypersensitivity? If so to which gender?

A

YES there is more female are seen to get it than males

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31
Q

What is a suggested reason why more females get hypersensitivity than men?

A

Could be due to better oral hygiene and some attend to use dental services more so their dentine hypersensitive would be diagnosed

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32
Q

On which SURFACES of the teeth is dentine hypersensitivity more frequent?

A

The buccal/ labial cervical areas of the teeth

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33
Q

List, from most to least, which teeth are affected by dentine hypersensitivity?

A
  1. First molars
  2. Canines
  3. Incisors
  4. Second premolars
  5. Molars
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34
Q

What does the distribution of dentine hypersensitivity correspond to?

A
  1. Areas of gingival recession
  2. Areas of thinning enamel
  3. Areas of cementum loss
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35
Q

Does every area of gingival recession have dentine hypersensitivity?

A

NO but every case of dentine hypersensitivity usually stems from gingival recession

36
Q

What are the 3 key factors that lead to a hypersensitive lesion?

A
  1. Dentine exposure (lesions localisation)
  2. Tubules made patent/open (lesion initiation)
  3. STIMULUS
37
Q

Is the pulp vital or non vital in a patent suffering from detente hypersensitivity?

A

Pulp will be vital

38
Q

Give example of stimuli that can trigger a dentine hypersensitivity response

A
  1. Thermal (Hot or cold)
  2. Osmotic hypertonic solutions (Sweet, spicy or acidic)
  3. Desiccation (drying of lesions may stimulate pain)
  4. Electrical (galvanic reactions and EPT)
  5. Tactile (touching probing or tooth brushing)
39
Q

Name the 3 proposed theories of sensitivity conduction

A
  1. Odontoblast as receptors
  2. Nerves in dentine
  3. Hydrodynamic mechanism
40
Q

Which of the 3 mechanism is the currently accepted one?

A

Hydrodynamic theory

41
Q

What has research shown about dentine having nerves and that causing sensitivity/

A

Only seen in 1% of tubules in the cervical margin, however electrical Curren and cold stimulate nerves directly

42
Q

Explain Brännströms hydrodynamic hypothesis

A
  1. Dentine hypersensitivity is caused by the movement of dentinal tubule contents
  2. Increased outward fluid low causes a pressure change across the dentine
  3. Distortion of A- delta fibre causes pain
43
Q

Where are the A delta fibres found?

A

Near the pulp

44
Q

Give the steps in the hydrodynamic mechanism of pulp nerve activation

A
  1. Stimulus
  2. Causes fluid flow
  3. Distorts and stimulates fibres
45
Q

What affects the severity of pain a dentine hypersensitivity patient may feel in response to a stimulus?

A

Width of the tubules

46
Q

What does the rate of fluid flow depend on?

A

Depends o the 4th power of the radius

So if a tubule is twice the width fluid flow is 16 times greater

47
Q

Does dentine hypersensitivity increase or decrease with age? Why?

A

Decreases as the size of the tubules decreases

48
Q

What does a slide of sensitive dentine show under a microscope?

A
  1. A distrusted smear layer
  2. Many more dentinal tubules at the surface
  3. Tubules not occluded by deposits
  4. Tubule diameter is wider
49
Q

What debates are going on surrounding the affect of the pulp in a patent with dentine hypersensitivity

A
  1. Does the pulp react to modify the sensitivity over time ?

2. With resolution of pulpal inflammation is there regression of sensitivity?

50
Q

What does dentine exposure result from?

A

Results from loss of enamel

51
Q

What can cause enamel loss?

A
  1. Removal of enamel by restorative treatment
  2. Attrition
  3. Abrasion
  4. Erosion
  5. Combined erosion and abrasion
52
Q

Does tooth brushing alone have a significant effect on hard tissues?

A

no

53
Q

How can toothbrushing slightly affect the teeth?

A

Toothpaste has the potential to abrade dentine considerably

Toothbrush bristles may indirectly contribute to abrasion

54
Q

How can tooth paste cause abrasion?

A
  1. Abrasive particles might remove the smear layer and open tubules
  2. Detergents might help to remove the smear layer
  3. Tubulents could be occluded with particulate matter from the paste
55
Q

What causes erosion?

A

Intrinsic or extrinsic sources of acid

56
Q

What is erosion?

A

It is the loss of enamel and dentine which can lead to surface softening

57
Q

How is tooth surface lost increased if the patients intra oral environment is acidic

A

By toothpaste abrasion if the intra oral environment is acidic

58
Q

What factors affect erosion?

A
  1. pH of the acid
  2. Type of acid
  3. Chemical strength
  4. Exposure time and frequency
59
Q

If a patient comes to you complaining of short sharp pains when they eat anything hot/cold/sugary what might they suffer from?

A

Dentine hypersensitivity BUT it could be other things too

60
Q

When carrying out the history, exam and diagnosis phase what must you note down?

A
  1. Record extent of recession
  2. Description of the mouth
  3. Record periodontal indexes
  4. Identify aetiological factors
61
Q

Do you need to record every mm of recession you see in your patients mouth?

A

No as a rule of thumb record any pockets/ recession over 3mm

62
Q

How is dentine hypersensitivity characterised?

A

Sharp pain that lasts as long as the stimulus is present

63
Q

What should your treatment plan be when you have a patient with dentine hypersensitivity

A
  1. Pain management
    2, Prevent progression
  2. Periodontal screening and early treatment
64
Q

Give the two ways we can manage dentine hypersensitivity

A
  1. Tubule occlusion

2. Blocking pulpal nerve response

65
Q

What does blocking tubule occlusion do?

A

It promotes the formation of new tissues (eg smear layer, intratubular dentine etc ) in response to a stimulus or trauma

66
Q

How can we block tubule occlusion?

A

By applying a artificial barrier eg a varnish, dentine bonding agents, composite resin, GIC and toothpaste

67
Q

out of the 2 methods of reducing hypersensitivity which one is more commonly carried out?

A

Tubule occlusion

68
Q

Why is blocking pulpal nerve response not a common way to treat dentine hypersensitivity?

A

As it is unproven in humans

Clinically it is unlikely that ions will diffuse into tubules against the flow of dentinal fluid

69
Q

List some ideal qualities of barrier materials for blocking tubule occlusion?

A
  1. Retentive
  2. Insoluble
  3. Penetrate tubules
  4. Form mechanical tags from tubules
  5. Must seal the tubules
70
Q

Give some home use products that can be used by patients to manage hypersensitivity

A

toothpastes, gels ad mouthwashes that contain potassium, strontium, oxalate and fluoride salts

71
Q

What must you tell patients when you recommend to them a home use product?

A

It requires long term use before results are apparent

72
Q

Why is it hard to evaluate the efficacy of dentine hypersensitivity products

A
  1. Pain perception is subjective and open to individual interpretation
  2. Psychological, medical, gender and cultural issues abound
  3. Stimulus varies
  4. The response is often complex
  5. We are unable to examine effects o subjects tissues
  6. Placebo effect
73
Q

What is percentage of the placebo effect on some of the toothpastes used to treat hypersensitivity?

A

40%

74
Q

What is good about strontium acetate ?

A

It withstands immersion in acid well

75
Q

Give examples of some in surgery products that are used to manage hypersensitivity

A
  1. Varnish
  2. 1-3 layers of adhesive resin bonding system
  3. Desensitising polishing paste
  4. Reinforced GIC where there is a cavity progression
76
Q

Give examples of varnish we use in surgery to manage hypersensitivity

A
  1. Duraphat

2. Clinpro

77
Q

What is duraphat made up of?

A

5% NaF

78
Q

What is clinpro made up of?

A

5% NaF and tricalcium phosphate

79
Q

Give examples of resin bonding systems we use in surgery to manage hypersensitivity

A
  1. Seal and protect
  2. Optibond solo
  3. Scothbond
80
Q

What do desensitising polishing pastes we use in surgery to manage hypersensitivity contain?

A

Calcium carbonate and arginine

81
Q

Describe the efficacy of fluoride varnish

A

Reasonable efficacy but dissolution over time

82
Q

Describe the efficacy of resins

A

Good if film thickness is adequate

83
Q

Describe the efficacy of GIC

A

Good at occlusion tubules where indicated for use

84
Q

Give some preventative advice can give to patients

A
  1. Change from damaging brushing techniques to modified bass technique or using an electric toothbrush
  2. Smoking cessation
  3. Try and eliminate traumatic habits
  4. Reduce risk factors associated with diet
85
Q

Why might we treat gingival recession surgically?

A
  1. Aesthetics
  2. Hypersensitivity
  3. Shallow root caries and abrasions

CSA SR (52 decks)

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