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Applied Dental Hygiene 2 > Gingival recession and dentine hypersensitivity > Flashcards

Gingival recession and dentine hypersensitivity Flashcards

1
Q

What is gingival recession?

A

The gingival margin is positioned apical to the cement-enamel junction with exposure of the root surface

CEJ to gingival margin

3mm

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2
Q

What is pocket depth?

A

Base of pocket to gingival margin

4.5mm

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3
Q

What is attachment level?

A

CEJ to base of pocket

7.5mm

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4
Q

What is the prevalence of gingival recession?

A

Recession of 1mm+ in 58% of adults 30+

Prevalence and extent increase with age

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5
Q

Who does gingival recession affect more?

A

Males more than females

Afro-Caribbeans more than white causasions

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6
Q

Where does gingival recession mostly affect?

A

Is more prominent on left side of jaw

Maxillary 1st molars and mandibular central incisors

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7
Q

Where does dentine hypersensitivity mostly affect?

A

Upper and lower canine

1st premolar and incisor teeth

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8
Q

Where is good oral hygiene associated with?

A

buccal surfaces

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9
Q

Where is poor oral hygiene associated with?

A

Lingual surfaces of lower anterior teeth

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10
Q

What 3 factors give rise to recession?

A
  • Anatomical position of tooth
  • Extent of cortical bone
  • Tooth position in arch
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11
Q

Why is there a greater risk of recession with orthodontic tooth movement?

A

excessive proclination of lower incisors and arch expansion

creation of dehiscence and is dependent on volume of soft tissue

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12
Q

Name the types of trauma that cause gingival recession

A

Foreign bodies eg lower lips piercings

Fingernail picking

Toothbrushing
- Hard toothbrush
- Frequency
- Frequency of changing brush
- Technique

Partial dentures
- May be poorly designed or maintained
- Oral hygiene may be poor

Direct trauma from malocclusion
- Leading to gingival stripping

Chemical trauma
- Eg topical cocaine

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13
Q

What is gingival biotype composed of?

A

height of keratinised tissue and tissue thickness

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14
Q

How does width and thickness affect gingival recession?

A

Thin, fragile tissue is predisposed to recession in presence of plaque-induced inflammation or trauma

  • Recession is more likely where gingivae is thin
  • Thickness of tissue is key
  • Height of keratinised tissue is not important
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15
Q

What are the local PRFs composed of?

A

High muscle attachment and frenal pull

Calculus

Restorative dentistry
- Subgingival margins increase plaque retention
- More pronounced inflammation seen in thin gingivae

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16
Q

What 2 things does periodontal disease lead to?

A

bone loss

apical migration of soft tissues (recession)

Recession can also be a side effect of treatment due to alleviation of gingival inflammation

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17
Q

What is a key risk factor in periodontitis?

A

Smoking

  • Causes recession in upper anterior palatal areas where smoke is upheld
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18
Q

What are the possible consequences of gingival recession

A

Fear of tooth loss

Plaque accumulation and bleeding gingivae

Aesthetics are compromised

Root caries

Abrasion

Pain from dentine hypersensitivity

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19
Q

What is dentine hypersensitivity?

A

characterised by a short, sharp pain arising from exposed dentine in response to certain stimuli

This can’t be explained as arising from any other dental defect or disease

It may go on to manifest as dull ache beyond the duration of the stimulus, possibly as an altered (irreversible) pulpal response

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20
Q

What is the epidemiology of dentine hypersensitivity?

A

Peak incidence is 20-40 years old

8-30% of time is perceived by patient or is self-reported

15-18% of time is diagnosed by clinicians in classic studies

Has 3.8% prevalence in more varied practice population

Affects females more than males

Occurs at an earlier age

  • Could be due to better oral hygiene
21
Q

Where does dentine hypersensitivity most frequently affect?

A

buccal/labial and cervical areas of teeth

22
Q

In order, what are most common teeth affected by dentine hypersensitivity?

A
  1. First premolars
  2. Canines
  3. Incisors
  4. Second premolars
  5. Molars
23
Q

Where does dentine hypersensitivity correspond to?

A

Areas of…
- Gingival recession
- Thinning enamel
- Cementum loss

24
Q

What 3 things in combination cause dentine hypersensitivity?

A
  • Dentine exposure (lesion localisation)
  • Tubules made patent (lesion initiation)
  • Stimulus

pulp must be vital

25
What could the stimuli be in dentine sensitivity?
Thermal Desiccation - Drying of lesion often stimulates pain - With evaporation of fluids, there may be a thermal element (lack of cooling) Osmotic (hypertonic solutions) - Sweet - Spicy - Acid - Microorganisms and metabolites maybe penetrate tubules Electrical - Galvanic reactions - May require electric pulp testing Tactile - Touching - Probing - Toothbrushing
26
What are some possible mechanisms in sensitivity conduction?
1. Odontoblasts act as receptors This is inconclusive 2. There are nerves in dentine Only seen in 1% of tubules in the cervical margin However, electrical current and cold stimulate nerves directly 3. Hydrodynamic mechanism This is currently the most accepted hypothesis
27
Explain Brannstrom hydrodynamic hypothesis
Dentine hypersensitivity is caused by the movement of dentinal tubule contents The increased outward fluid flow causes a pressure change across the dentine This causes a distortion in A-delta fibres, which then causes pain
28
Why may an electrical process be involved in dentine hypersensitivity?
The fluid flow charges also result in an electrical discharge This may be able to stimulate nerves directly
29
Why is the width of the tubules important?
The rate of fluid flow depends on 4th power of the radius So, if a tubule is twice the width, then the fluid flow is 16x greater
30
What does sensitive dentine show?
A disrupted smear layer Many more dentinal tubules at surface Tubules are not occluded by deposits The tubule diameter is wider
31
What is the current debate about pulp in regards to dentine hypersensitivity?
What is the degree? Does pulp react to modify sensitivity over time? With resolution of inflammation, is there regression of sensitivity?
32
What is root caries?
dentine hypersensitivity from gingival recession due to periodontal disease and treatment There may be potential microorganisms invading the root dentinal tubules – there may be different aetiology
33
What are the 5 reasons for enamel loss leading to dentine exposure?
- Restorative procedures - Attrition (not in cervical buccal lesions) - Abrasion - Erosion - Combined erosion and abrasion
34
What are the factors for acid in erosion?
pH Type Chemical strength Temperature Exposure time Others
35
Why does cementum wear?
When gingival recession occurs, the root surface is exposed Cementum is a relatively weak structure in a thin layer wear and tear including toothbrushing readily remove cementum
36
What are 2 ways we can manage dentine hypersensitivity?
tubule occlusion - promotes the formation of new tissue blocking plural nerve response - Potassium ions diffuse along tubules and raise its extracellular concentration – this reduces its nerve excitability
37
What are the ideal qualities of barrier materials?
- Retentive - Insoluble - Penetrates the tubules - Forms mechanical tags into the tubules - Then seals the end of the tubules
38
What are some key-ingredients in home-use products?
- Potassium - Strontium - Oxalate - Fluoride salts - Potassium nitrate, Cochrane review states no clear evidence - Novamin (releases calcium and phosphate ions from saliva to give a hydroxyapatite-like layer)
39
How can we evaluate the efficacy of home-use management?
inherent problems with clinical trials Pain perception is subjective, qualitative and open to individual interpretation Psychological, medical, gender and cultural issues are many in number Stimulus is either variable or fixed Response is often complex Are unable to examine effects on subject’s tissue The placebo effect
40
Is there any in-vitro evidence of good tubule occlusion?
Yes With strontium acetate products which withstands immersion in acids well
41
What are some in-surgery products to manage hypersensitivity?
Varnish eg Duraphat (5% NaF), Clinpro (5% NaF and tricalcium phosphate) 1-3 layers of adhesive resin bonding systems eg Seal and Protect, Optibond Solo, Scotchbond 1 (is etchant required?) Desensitising polishing paste (calcium carbonate and arginine) We should reinforce GIC where there is abrasion cavity progression Watch for any overhangs at gingival margin
42
How can we compare the efficacy of these in-surgery products?
fluoride varnish - reasonable efficacy but dissolution occurs over time Resins - good if film thickness is adequate - These products do not require etching GIC - Good at occluding tubules where indicated for use
43
What is some preventative patient advice that could be offered?
Change from damaging brushing techniques to… - Modified bass technique - Roll technique - Electric toothbrush Eliminate traumatic habits Smoking cessation (VBA: ask, advise, act) Reduce risk factors… - Take diet history - Limit acidic drinks and do not brush immediately after - Night-time splints if there is wear from bruxism
44
How can we treat root caries?
Take radiographs to detect root caries interproximally Prioritise prevention… - Diet - OHI - Fluoride (mouthrinses, gels, custom made trays, topical professional application) Recontour shallow lesions Restore with GIC
45
How can we treat periodontitis?
Initial therapy Corrective therapy Supportive therapy
46
How can we restore aesthetics of gingival recession?
Removable gingival veneer (silicone or acrylic) - This works to mask and cover the black triangles of interdental spaces Crowns and veneers (not removable) - Veneers are made from a pink and tooth coloured composite Root coverage treatments
47
What are some indications of surgical management for root coverage?
Aesthetics Hypersensitivity Shallow root caries and abrasions
48
What are some contraindications of surgical management for root coverage?
Poor OH Usual medical contraindications for periodontal surgery Smoking will prevent post-operative healing
49

Applied Dental Hygiene 2 (8 decks)

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