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293- Clinical Dental Hygiene > Hypersensitivity > Flashcards

Hypersensitivity Flashcards

1
Q

What are some types of tactile stimuli?

A

Denture clasps
Toothbrushing
Dental Instrumentation
Thermal (hot, cold, food air)

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2
Q

What is evaporative stimuli?

A

Dehydration of oral fluids (HVE/air-water syring)

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3
Q

What is osmotic stimuli?

A

Alteration of pressure in dentinal tubules through a selective membrane

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4
Q

What are some chemical stimuli?

A

Acids (wine, citrus)
Some spices
Whitening products
Carbonated beverages
Acidogenic carb exposure
Gastric regurgitation

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5
Q

Characteristics of hypersensitivity

A

Sharp, short pain
Transient pain
Rapid onset
Presents as chronic condition with acute episodes
Caused by stimuli that does not normally cause pain

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6
Q

Qualities of the dentition that aid in hypersensitivity

A

Dentinal tubules filled w/ fluid
Pulp highly innervated
Nerve fibers closer to pulp, wrap around odontoblastic processes
Tubules are wider and more numerous in sensitive areas

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7
Q

What leads to dentin exposure? What may cause this to happen?

A

Gingival recession>loss of cementum or enamel>dentin exposure

-tooth brush abrasion
-fractured tooth
-decrease in pH

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8
Q

What factors may cause gingival recession?

A

-tooth brush abrasion
-short frenum
-apical migration due to periodontal disease
-gingival shrinkage
-perio surgery
-orthodontic movement
-metal jewelry

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9
Q

What is abfraction?

A

Wedge-shaped cervical lesion
From lateral/occlusal stress
Enamel rods chip away
Malocclusion or clenching can be factors
Night guards may be required

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10
Q

What is Brannstrom’s theory on hypersensitivity?

A

Hydrodynamic theory

Stimulus on outer aspect causes movement of fluid in dentinal tubules

Transmits pain by stimulating nerves in the pulp

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11
Q

What are some types of natural desensitization?

A

Sclerosis of dentin
Secondary dentin

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12
Q

What is sclerosis of dentin?

A

Occurs from traumatic stimuli
Thicker layer of peritubular dentin is formed
Results in smaller diameter tubules w/ less ability for fluid movement

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13
Q

What is secondary dentin?

A

Creates a walling off effect from the dentin to the pulp
Happens gradually over time
Happens with aging, results in smaller pulp size

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14
Q

What is a smear layer?

A

Organic and inorganic debris covers the tubules
Accumulates after SRP, abrasive TP, attrition abrasion
Occludes tubules, blocking stimuli
Changes constantly- ex. from acid exposure, ultrasonic

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15
Q

How does calculus work as a natural desensitizer?

A

Provides a blanketing effect
Covers exposed dentin

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16
Q

What is the prevalence of hypersensitivity?

A

Affects mostly 18-44 year olds
More so in perio disease populations
Occurs primarily at cervical 3rd

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17
Q

While recession is more prevalent with aging, why is sensitivity not?

A

Secondary dentin forms over time with aging, walling off the pulp from dentin and making the pulp smaller

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18
Q

How can acute pain affect people mentally?

A

May cause anxiety

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19
Q

How can chronic pain affect people mentally?

A

May cause depression

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20
Q

What is the etiology of pain?

A

Can be systemic, pulpal, periapical or restorative

Differential diagnosis is needed to determine treatment

21
Q

What is most often the cause of pulpal pain upon chewing?

A

Fractured teeth

22
Q

What can cause pulpal pain?

A

Deep dental caries
Infection
Fracture
Pulpal inflammation

23
Q

How is pulpal pain characterized?

A

Severe
Lasts longer
Intermittent
Throbbing
Sometimes worse at night

24
Q

What open ended questions would you ask when trying to come up with a differential diagnosis?

A

Location?
Degree of pain
Onset/duration
Source of stimuli
Intensity
Alleviating factors

25
Q

What do we do as clinicians to determine causes of pts pain when they are confused or cannot tell us?

A

Visual assessment
Palpation
Evaluation of sinuses
Articulating paper to check occlusion
Radiographs
Percussion
Check mobility
Bite stick
Transillumination
Thermal pulp testing

26
Q

What else can we use to determine etiology of pain?

A

Discussion of diet
Do they have adequate HC? Does this contribute?
Clenching/bruxing?

27
Q

What are our treatment goals with these patients?

A

Pain relief
Eliminate or reduce contributing factors

28
Q

What kind of approach do we use for mild/moderate pain and severe pain?

A

Conservative for mild/mod (sens.TP)
Aggressive for severe (filling tooth)

Try most conservative first
Trial and error may be necessary
Evaluate interventions after 2-4 weeks

29
Q

How do desensitizing agents work?

A

Prevent nerve depolarization
Prevents stimulus from moving through tubules

30
Q

What is the only type of desensitizing agent that prevents depolarization?

A

Potassium nitrate (potassium salts)
-Found in Sensodyne

31
Q

What habit changes can we aid our pts in?

A

Encourage diet changes
Help pt schedule brushing time w/ acid consumption
Guide them towards non-acidic mouthwashes
Biofilm control (tubules decrease by 20% after removal)
Referral for eating disorders
Avoid discomforting stimuli

32
Q

Toothbrushing tips for sensitivity

A

Soft toothbrushing
Short strokes
End in more senesitive areas
Use non-dominant hand
Power toothbrush

33
Q

What are the requirements for desensitizing agents?

A

Rapid acting
Long-term effects
Non-irritating to the pulp
Painless
Easy to apply
No staining

34
Q

How are desensitizing agents categorized?

A

By their mechanism of action

35
Q

What are the 3 types of potassium salts that reduce depolarization?

A

Potassium nitrate
Potassium oxalate
Potassium chloride

36
Q

How does potassium nitrate work?

A

Penetrates into tubules and reaches nerves
Blocks nerve signals that trigger pain
Takes several uses before effective

37
Q

How does fluoride work as a desensitizing agent?

A

Precipitates in tubules causing decrease in lumen diameter
Creates a barrier blocking tubules
Can be varnish or gel

38
Q

How do oxalates work as desensitizing agents? What kinds?

A

Block tubules- works fast
K+ oxalate
Ferric Oxalate

39
Q

How does calcium phosphate work as a desensitizing agent?

A

Releases calcium and phosphate into saliva for formation of hydroxyapatite
Occludes tubules
-used for caries control
-do not use w/ fluoride, will bind

40
Q

When was amorphous calcium phosphate (ACP) introduced? What does it due and where can it be found?

A

-1991
- Plugs tubules
- Calcium and phosphate ions release in saliva (not stable)
- Found in prophy paste, fluoride and TP

41
Q

How does calcium sodium phosphoscilicate work? How is it delivered?

A

NovaMin
Calcium and phosphate form a layer on the tooth and crystalizes to form hydroxyapatite

Delivered in solid bioactive glass particles- reacts with saliva

Found in air powder polish

42
Q

What is the brand name for casein phosphopeptide- amorphous calcium phosphate (CPP-ACP)? Who can it not be used on?

A

Recaldent

Cannot be used on people with dairy allergies- contains a milk derived protein

Can be formulated w/ or w/o fluoride

43
Q

How is tricalcium phosphate used?

A

Helps to remineralize teeth- deposits an acid-resistant material
Added to varnish 5%
Occludes dentin tubules
Created to be able to work w/ fluoride

44
Q

When would you use arginine and calcium phosphate? Why?

A

Use before phrophylaxis to reduce sensitivity during scaling.
Plugs dentinal tubules and helps maintain neutral pH

45
Q

What desensitizing agents are found in self-applied forms?

A

Dentifrices can contain:
- 5% potassium nitrate
- Fluoride
- Stannous fluoride

46
Q

What types of self-aplied desensitizers are available?

A

Toothpastes
Mouthrinses
Gels

47
Q

What are some types of professionally applied desensitizers?

A

Fluoride gel trays
Fluoride varnish
Oxalates
Unfilled/partially filled resins
Dentin bonding agents
Glass ionomer
Soft tissue graft

48
Q

Why does tooth whitening cause sensitivity? What can be used to prevent this?

A

-Byproducts pass through tubules
-HP contacts pulp- no harm
-Dehydration of tooth
-Desensitizing can be done for 2 weeks leading up to whitening procedure
-Encourage a recovery period between treatments using an agent

293- Clinical Dental Hygiene (11 decks)

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